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Safe Alternative (safe + alternative)
Selected AbstractsChemInform Abstract: Indium(III) Chloride Catalyzed Oxidative Cleavage of Carbon,Carbon Multiple Bonds by tert-Butyl Hydroperoxide in Water , A Safe Alternative to Ozonolysis.CHEMINFORM, Issue 31 2008Brindaban C. Ranu Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a "Full Text" option. The original article is trackable via the "References" option. [source] ChemInform Abstract: NaBH4 in N-Methylpyrrolidone: A Safe Alternative for Hydride Displacement Reaction.CHEMINFORM, Issue 4 2002Yasuhiro Torisawa Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 100 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a "Full Text" option. The original article is trackable via the "References" option. [source] ChemInform Abstract: One-Carbon Homologation of Carboxylic Acids via BtCH2TMS: A Safe Alternative to the Arndt,Eistert Reaction.CHEMINFORM, Issue 50 2001Alan R. Katritzky Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 100 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a "Full Text" option. The original article is trackable via the "References" option. [source] "Unknown Risks" of non-steroid topical medications for atopic dermatitisINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2007Anne Marie McNeill PhD Introduction, Tacrolimus ointment is a nonsteroid treatment for atopic dermatitis which is both effective and has a minimal side-effect profile. However, some clinicians may be reluctant to use tacrolimus ointment due to the "unknown risks", meaning those that have not been uncovered in human studies conducted thus far. Therefore, the available animal data regarding the "unknown risks" of topical tacrolimus therapy are reviewed, and a discussion of the interpretation of this available but limited data is presented. Animal studies, Some of the fear on the part of clinicians regarding the use of topical tacrolimus may come from the results of animal studies which showed an increase in lymphoma and UV-induced skin cancer after treatment with topical tacrolimus in animal models of carcinogenesis. However, rigorous assessment of these studies suggest that it is somewhat likely that these represent a species-specific response to tacrolimus in an animal already predisposed to tumor formation, and therefore may not be relevant in assessing the possibility of an increased human health risk. Conclusions, Animal and human studies suggest that topical tacrolimus is a safe alternative to topical steroids, with the major known adverse effect being a transient burning sensation, compared with the known adverse effects of topical steroids, including long-lasting ones. Therefore, in the opinion of the authors, currently available data, including animal studies, does not suggest that "unknown risks" of topical tacrolimus need be any more concerning than the known side-effects of the topical steroids. [source] Reduction of Alkyl Halides by Triethylsilane Based on a Cationic Iridium Bis(phosphinite) Pincer Catalyst: Scope, Selectivity and MechanismADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 1-2 2009Jian Yang Abstract A highly efficient procedure for the reduction of a broad range of alkyl halides by triethylsilane based on a cationic iridium bis(phosphinite) pincer catalyst has been discovered and developed. This reduction chemistry is chemoselective and has unique selectivities compared with conventional radical-based processes and the aluminum trichloride/triethylsilane (AlCl3/Et3SiH) and triphenylmethyl tetrakis[pentafluorophenyl]borate/triethylsilane {[Ph3C] [B(C6F5)4]/Et3SiH} systems. Reductions use three equivalents of triethylsilane relative to the halide and can be carried out with very low catalyst loadings and in a solvent-free manner, which may provide an environmentally attractive and safe alternative to many currently practiced methods for reduction of alkyl halides. Mechanistic studies reveal a unique catalytic cycle. The cationic iridium hydride 2,6-bis[di-(tert -butyl)phosphinyloxy)phenyl(hydrido)iridium, (POCOP)IrH+ {POCOP= 2,6-[OP(t- Bu)2]2C6H3} binds and activates the silane. This complex serves as a potent silylating reagent to generate silyl halonium ions, Et3SiXR+, which are reduced by the neutral iridium dihydride to yield alkane product and regenerate the cationic (POCOP)IrH+, thus closing the catalytic cycle. All key intermediates have been identified by in situ NMR monitoring and kinetic studies have been completed. An application of this reduction system to the catalytic hydrodehalogenation of a metal chloride complex is also described. [source] Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms in High-Risk Patients:JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2004A Single Center Experience Background: Endovascular stent graft (EVG) repair can be a safe alternative to open surgical repair to treat abdominal aortic aneurysms (AAA) in high-risk patients. We report our results with EVG repair in such high-risk patients at our institution. Objectives: We wanted to show that EVG repair can be performed successfully and with a low complication rate in patients with serious comorbidities. Methods: All patients prospectively studied underwent EVG repair of AAA from February 2000 to July 2002. Results: Of the 60 patients studied, 45 (75%) were high-risk surgical candidates because of associated comorbidities; their aneurysms ranged from 4.5 to 10 cm (mean: 5.7 ± 1.2 cm). Fifty-nine of 60 patients (98.3%) were treated successfully. Two (3.3%) who underwent surgical intervention for site-related complications died from postoperative complications. Hospital stay was <48 hours in 46 (77%) patients. Conclusion: Our preliminary results show that EVG is safe, feasible, and yields excellent technical success even in patients at high risk for complications. Teamwork between interventional cardiologists and vascular surgeons is advised. (J Interven Cardiol 2004;17:71,79) [source] Imaging and intervention of retroperitoneal fibrosisJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2007T Geoghegan Summary Retroperitoneal fibrosis is a rare condition characterized by the development of fibrous plaques in the retroperitoneal space. The fibrous plaques characteristically arise distal to the bifurcation of the abdominal aorta and progress to encase the iliac vessels distally and are defined by the associated encasement of one or both ureters. Imaging plays an important role in not only establishing the diagnosis, but also in monitoring disease progression. Historically, the radiological diagnosis was made predominantly by intravenous urography and retrograde pyelography. More recently, advances in cross-sectional imaging with ultrasound and contrast-enhanced CT have allowed for a more precise diagnosis as well as helping to accurately define the extent of the disease. At our institution, we have found ultra-fast MRI to also play a useful role in establishing the diagnosis. In particular, magnetic resonance urography using HASTE (half Fourier-acquired single shot turbo spin-echo) sequences allow a safe alternative to intravenous urography, particularly in patients with poor renal function. The purpose of this article is to describe the role of the various imaging methods available to the radiologist and to emphasize the important role that the interventional radiologist now plays, not only in obtaining tissue for diagnosis, but also in providing treatment of the disease by percutaneous nephrostomy drainage and subsequent stent placement in select cases. [source] Complex liver resection for a large intrahepatic cholangiocarcinoma in a Jehovah's witness: A strategy to avoid transfusionJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2007FRCS, Omar Barakat MD Abstract Although morbidity and mortality after liver resection have improved over the last two decades, complex liver resections still require perioperative blood transfusions. In this report, we describe the use of a combined left trisegmentectomy and caudate lobectomy, along with resection of the inferior vena cava, to treat a large intrahepatic cholangiocarcinoma in a Jehovah's Witness. To our knowledge, this is the first report of major liver resection for a large malignant tumor in this patient population. We also discuss the perioperative strategy and surgical technique we used to minimize blood loss and avoid transfusion. This approach could be a safe alternative for use in all patients with complex liver tumor, regardless of their religious beliefs, to reduce the risks and cost associated with blood transfusion. J. Surg. Oncol. 2007;96: 249,253. © 2007 Wiley-Liss, Inc. [source] Effects of linearly polarized 0.6,1.6 ,M irradiation on stellate ganglion function in normal subjects and people with complex regional pain (CRPS I)LASERS IN SURGERY AND MEDICINE, Issue 5 2003Jeffrey R. Basford MD Abstract Background and Objectives Stellate ganglion blocks are an effective but invasive treatment of upper extremity pain. Linearly polarized red and near-infrared (IR) light is promoted as a safe alternative to this procedure, but its effects are poorly established. This study was designed to assess the physiological effects of this latter approach and to quantitate its benefits in people with upper extremity pain due to Complex Regional Pain Syndrome I (CRPS I, RSD). Study Design/Materials and Methods This was a two-part study. In the first phase, six adults (ages 18,60) with normal neurological examinations underwent transcutaneous irradiation of their right stellate ganglion with linearly polarized 0.6,1.6 ,m light (0.92 W, 88.3 J). Phase two consisted of a double-blinded evaluation of active and placebo radiation in 12 subjects (ages 18,72) of which 6 had upper extremity CRPS I and 6 served as "normal" controls. Skin temperature, heart rate (HR), sudomotor function, and vasomotor tone were monitored before, during, and for 30 minutes following irradiation. Analgesic and sensory effects were assessed over the same period as well as 1 and 2 weeks later. Results Three of six subjects with CRPS I and no control subjects experienced a sensation of warmth following active irradiation (P,=,0.025). Two of the CRPS I subjects reported a >50% pain reduction. However, four noted minimal or no change and improvement did not reach statistical significance for the group as a whole. No statistically significant changes in autonomic function were noted. There were no adverse consequences. Conclusions Irradiation is well tolerated. There is a suggestion in this small study that treatment is beneficial and that its benefits are not dependent on changes in sympathetic tone. Further evaluation is warranted. Lasers Surg. Med. 32:417,423, 2003. © 2003 Wiley-Liss, Inc. [source] 3T MR of the prostate: Reducing susceptibility gradients by inflating the endorectal coil with a barium sulfate suspensionMAGNETIC RESONANCE IN MEDICINE, Issue 5 2007Yael Rosen Abstract Most prostate MRI/MRS examinations are performed with an endorectal coil inflated with air, leading to an air,tissue interface that induces magnetic susceptibility gradients within the gland. Inflation of the coil with a barium sulfate suspension is described and compared to inflation with air or liquid perfluorocarbon (PFC). The B0 field in the prostate gland was mapped for five healthy volunteers when the endorectal coil was inflated with each of the three agents. A marked decrease in the posterior-anterior (P-A) field gradient and a significant improvement in field homogeneity were evident in the presence of a barium suspension and PFC relative to air. MRS data acquired from the prostate gland in the presence of air, PFC, and a barium suspension in the endorectal coil showed similar trends, demonstrating improvement in line-widths and spectral resolution when the barium suspension or the PFC were inflating the endorectal coil. On this basis we conclude that a barium suspension provides an available, cheap, and safe alternative to PFC, and we suggest that inflating the endorectal coil with a barium suspension should be considered for prostate MR studies, especially at high field strengths (such as 3T). Magn Reson Med 57:898,904, 2007. © 2007 Wiley-Liss, Inc. [source] Therapeutic Effects of Vitamin E on Cyclic MastalgiaTHE BREAST JOURNAL, Issue 5 2009Sousan Parsay PhD Abstract:, Cyclic mastalgia is one of the most prevalent disorders among fertile women. To date, hormonal agents, despite their side effects, have been widely used for treatment of this ailment. This study was performed to clarify the therapeutic effects of Vitamin E (Vit E) as a safe treatment for cyclic mastalgia among fertile women. This study was conducted as a double blind clinical trial; 150 women with cyclic mastalgia, referred by three public health centers in Qazvin City in Iran, were enrolled in the trial and randomly divided into two distinct case and control groups; each containing 75 patients. The severity and duration of breast pain were measured according to both the Cardiff Breast Pain Chart and the Visual Analog Scale. Simple, chewable tablets of either Vit E or a placebo were prescribed twice a day for 4 months for case and control participants, respectively. Follow-up was performed at the end of both the second and the fourth months and, at that time, the severity, duration and side effects of intervention were evaluated. The administration of Vit E had significant curative results as tested at both the 2- and 4-month benchmarks. Chi-square testing indicated that after both 2 and 4 months of therapy, the efficacy demonstrated by the Vit E recipient case group was superior to that of the group that received a placebo. Applying the Mc Nemar Test, it also was shown that there was no significant difference in the benefits received between treatment courses of 2 versus 4 months. A 2-month prescription of Vit E has positive therapeutic effects on cyclic mastalgia. Given its lack of significant side effects, Vit E, therefore, can be considered a safe alternative to hormonal therapies currently being used in the treatment of cyclic mastalgia. [source] Retropharyngeal Lipoma Causing Obstructive Sleep Apnea: Case Report Including Five-Year Follow-Up,THE LARYNGOSCOPE, Issue 9 2002Neil G. Hockstein MD Abstract Objectives/Hypothesis Lipomas of the retropharyngeal space are rare and do not cause symptoms until they reach a large size. Although retropharyngeal lipoma is an uncommon entity, several reports of it appear in the literature, and the treatment has routinely been surgical excision. Such fatty tumors also carry the rare possibility of being liposarcomas, which further warrants their excision. We present the case of a lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum causing symptoms of obstructive sleep apnea. The patient had multiple medical problems and was on a regimen of anticoagulation therapy; therefore, he opted against surgical treatment. He has used continuous positive airway pressure and has been followed clinically and radiographically for 5 years. Radiographic follow-up of a retropharyngeal lipoma after a needle biopsy confirming its benign nature is a legitimate means of management of this rare condition. Study Design Case report of a 64-year-old man presenting with this rare lesion. Methods Computed tomography-guided needle biopsy of the mass was performed to obtain tissue diagnosis. Thereafter, the patient has been followed for 5 years with annual magnetic resonance imaging scans to determine growth or changes of the retropharyngeal mass. Results Fine-needle aspiration of the mass revealed mature adipose tissue intermixed with fibroconnective tissue, consistent with lipoma. Based on this result, we opted to follow this patient with serial magnetic resonance imaging scans, which have shown no change in size. There has also been no change in the patient's symptoms. Conclusions Large lipomas warrant excision, especially when their location produces pressure symptoms. However, when surgical morbidity is high, fine-needle aspiration biopsy and serial magnetic resonance imaging scans are a safe alternative. [source] Minimally invasive surgery for esophageal cancerASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2010AJ Greenstein Abstract Background: Esophageal cancer is among the most deadly cancers worldwide, and esophagectomy remains the standard of care in trying to cure this. Efforts to decrease the incidence of complications in esophagectomy without compromising the efficacy of the procedure have stimulated interest in minimally invasive esophagectomy (MIE), and a wide variety of MIE techniques have been refined by surgeons at specialized centers worldwide. Data sources: Systematic PubMed searches identified articles related to MIE technique, complications, and outcomes. Conclusions: Several techniques have been developed for MIE, none of which has been deemed superior, but as a whole, they represent a safe alternative to open surgery. Available results from case series and comparative studies suggest trends towards improved short-term outcomes with equivalent efficacy but without definitive advantages. [source] Mutation of surface residues to promote crystallization of activated factor XI as a complex with benzamidine: an essential step for the iterative structure-based design of factor XI inhibitorsACTA CRYSTALLOGRAPHICA SECTION D, Issue 10 2005Pramod Pandey Activated factor XI (FXIa) is a key enzyme in the amplification phase of the blood-coagulation cascade. Thus, a selective FXIa inhibitor may have lesser bleeding liabilities and provide a safe alternative for antithrombosis therapy to available drugs on the market. In a previous report, the crystal structures of the catalytic domain of FXIa (rhFXI370,607) in complex with various ecotin mutants have been described [Jin et al. (2005), J. Biol. Chem.280, 4704,4712]. However, ecotin forms a matrix-like interaction with rhFXI370,607 and is impossible to displace with small-molecule inhibitors; ecotin crystals are therefore not suitable for iterative structure-based ligand design. In addition, rhFXI370,607 did not crystallize in the presence of small-molecule ligands. In order to obtain the crystal structure of rhFXI370,607 with a weak small-molecule ligand, namely benzamidine, several rounds of surface-residue mutation were implemented to promote crystal formation of rhFXI370,607. A quadruple mutant of rhFXI370,607 (rhFXI370,607 -S434A,T475A,C482S,K437A) readily crystallized in the presence of benzamidine. The benzamidine in the preformed crystals was easily exchanged with other FXIa small-molecule inhibitors. These crystals have facilitated the structure-based design of small-molecule FXIa inhibitors. [source] Single dose oral azithromycin versus seven day doxycycline in the treatment of non-gonococcal mucopurulent endocervicitisAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2000Fatih SUMMARY The aim of this study was to compare single dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal mucopurulent cervicitis (MPC). One hundred and thirty-one women with non-gonococcal MPC were enrolled in a prospective-randomised study to compare the efficacy and safety of a single oral dose of 1 g azithromycin and a seven-day course of 100 mg doxycycline twice daily Clinical examination and culture samples for Chlamydia trachomatis and other microorganisms were performed before and approximately 14 days after starting the treatment. Of the 131 women recruited (67 in the azithromycin group and 64 in the doxycycline group), Ureaplasma urealyticum was isolated from 21 (16%); Chlamydia trachomatis from 15 (11.5%); and Mycoplasma hominis from 3 (2.3%) of the patients at the initial examination. The eradication rate of baseline culture-positive cases at the follow-up visit in the azithromycin group was 71.4%, and 77.3% in the doxycycline group. There was no statistically significant difference in efficacy between the single dose azithromycin and seven-day course of doxycycline in the treatment of culture-positive cases. Azithromycin 1 g appears to be an effective and safe alternative to doxycycline for the treatment of non-gonococcal MPC. [source] Manual vacuum aspiration: a safe alternative for the surgical management of early pregnancy lossBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2009DS Milingos Manual vacuum aspiration (MVA) is an alternative to the standard surgical curettage, performed under local anaesthetic in the setting of a treatment room. The aim of our study was to assess the efficacy of MVA in the management of first trimester early fetal demise and first- and mid-trimester incomplete miscarriage. This was a retrospective study of 246 patients who were scheduled to undergo MVA for first trimester early fetal demise and first- and mid-trimester incomplete miscarriage. One woman was excluded in the analysis because of the procedure being abandoned prior to MVA. Efficacy of the procedure was 94.7% (232/245). Incomplete uterine evacuation was seen in 5.3% (13/245) patients. Although not widely used in the UK, MVA could be considered routinely, thus avoiding general anaesthesia and the need for access to theatre. [source] Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2005M.A. Hefni Objective To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. Design Randomised controlled trial. Setting Gynaecology Department, Benenden Hospital, Kent. Population One hundred and sixteen women undergoing vaginal hysterectomy were prospectively randomised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles. Methods Data of patients were collected prospectively. Statistical analysis was performed using the Mann,Whitney U test, ,2 and Fisher's exact test as appropriate. Main outcome measures Operating time, operative blood loss and peri-operative complications. Results The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P= 0.433), but peri-operative haemorrhagic complications were less frequent in the LigaSure group (0%vs 6.8%, P= 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post-operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles. Conclusion The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery. [source] Medical management of early fetal demise using sublingual misoprostolBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2002Prabhath T. Wagaarachchi The aim of this study was to determine the efficacy of mifepristone in combination with sublingual misoprostol for the medical management of early fetal demise. Fifty-six consecutive women were studied prospectively. The mean (SD) gestation at diagnosis was 9.6 weeks (1.84). Four women had complete miscarriage with mifepristone alone. The overall success rate was 83.9% and the median induction,miscarriage interval was 8.19 hours (range 0.83 to 37.50 hours). Of those women who had a successful outcome, 91.5% were satisfied with the regimen. Sublingual misoprostol in combination with mifepristone is an effective and safe alternative to vaginal or oral misoprostol in the management of early fetal demise. [source] Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulationBJU INTERNATIONAL, Issue 9 2002W.A. Scheepens Objective ,To assess the long-term efficacy and safety of two-stage sacral neuromodulation with an implantable pulse generator (IPG) in patients treated for urinary urge incontinence (UI) and/or urinary retention (UR). Patients and methods ,The two-stage technique is used if patients have a good response during the acute phase of the percutaneous nerve evaluation (PNE) test, but have a poor response during the following 4,7 days (subchronic phase). In the first stage only the permanent electrode was implanted and connected to a temporary external stimulator, allowing patients to be assessed for longer. If the main symptoms improved by more than half the patient proceeded to the second stage, the insertion of the IPG. We reviewed all patients who underwent two-stage implantation; all had signed an informed consent and were asked to complete voiding diaries and a questionnaire to assess the subjective effects of the therapy. Safety was assessed from relevant medical events, management, and relative to the thera-py and resolution. Residual urine was assessed by self-catheterization. The long-term voiding diary results were compared with baseline estimates and analysed statistically using the two-sided Student's t -test. Results ,Between 1991 and 1998, 15 patients (13 women and two men, mean age 53 years, range 44,66) underwent the two-stage technique; the mean (median, range) follow-up was 4.9 (5.2, 2.5,7.5) years. Seven patients had UI and seven had UR, with one having both. The mean (range) number of PNEs undertaken in each patient was 2.1 (1,4) and these all failed in the subchronic phase. All patients underwent a first- and second-stage implant after a mean (range) screening period of 12.2 (2,29) days. One patient was explanted after implantation of only the first stage, and two others explanted in a later phase because the IPG was ineffective during the follow-up. The voiding diary results of the remaining 12 patients showed improvement in all the main variables, and in the subjective assessment 11 reported an improvement and were satisfied with the therapy. There were 17 adverse events, 14 of which were resolved and seven of which required surgical intervention. Conclusion ,The long-term results of the two-stage implantation show clinically and statistically significant improvements, probably because the implantation of the lead (first stage) more closely resembles the final therapy. If a temporary PNE test is not optimal (lead migration, longer testing needed), the two-stage technique can offer a good and safe alternative of comparable efficacy in the long-term. If the two-stage technique had not been available to these 12 patients they would not have been offered neuromodulation. [source] Arterioportal shunting as an alternative to microvascular reconstruction after hepatic artery resectionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2004S. Kondo Background: Portal vein and hepatic artery resection and reconstruction may be required in radical surgery for biliary cancer. Microvascular reconstruction requires special equipment and training, and may be difficult to accomplish when the arterial stump is small, when there are multiple vessels or when the stump lies deep within the wound. This study examined the feasibility and safety of arterioportal shunting as an alternative to arterial reconstruction. Methods: Over 30 months, ten patients with biliary cancer (six bile duct and four gallbladder carcinomas) underwent radical surgery with en bloc resection of the hepatic artery and end-to-side arterioportal reconstruction between the common hepatic or gastroduodenal artery and the portal trunk. Results: No patient died. Complications included bile leakage in two patients and liver abscess in one. Routine angiography performed 1 month after surgery revealed shunt occlusion in three patients. Once the existence of hepatopetal arterial collaterals had been confirmed in the remaining patients, the shunt was occluded by coil embolization. Conclusion: Arterioportal shunting appears to be a safe alternative to microvascular reconstruction after hepatic artery resection. However, the safety of the procedure and its potential to increase the cure rate require further assessment in a larger series with a longer follow-up. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Comparison of laser in situ keratomileusis reoperation outcomes with the Moria M2 head 90 and 130 following previous photorefractive keratectomy or laser in situ keratomileusisACTA OPHTHALMOLOGICA, Issue 3 2010Antti Pitkänen Abstract. Purpose:, To compare the Moria Model Two (M2) automated microkeratome with the head 90 (intended to create a 120-,m flap) to the head 130 (intended to create a 160-,m flap) in reoperations following previous photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) in terms of accuracy, predictability, safety and complications of the procedure. Methods:, Eighty-five eyes of 70 consecutive patients received LASIK with the Moria M2 microkeratome. Nine previously PRK-operated eyes were reoperated with the head 90 and 37 eyes were reoperated with the head 130. Repeated LASIK was performed on 16 eyes with the head 90 and on 23 eyes with head the 130. Flap dimensions were measured and correlated to preoperative parameters. Results:, The average flap thickness in the previously PRK-operated eyes was 115.1 ,m [range 82,137 ,m, standard deviation (SD) 17.9] with the head 90 and 131.2 ,m (range 105,171 ,m, SD 19.8) with the head 130. In the previously LASIK-operated eyes, the mean flap thickness was 139.2 ,m (range 92,182 ,m, SD 23.8) with the head 90 and 141.9 ,m (range 109,179 ,m, SD 15.2) with the head 130. There were no free or incomplete flaps or flaps with buttonholes in the study. There was no statistically significant difference in postoperative uncorrected visual acuity (UCVA) between the groups. Conclusion:, In eyes with previous PRK or LASIK, LASIK reoperation offers a safe alternative for improving refractive outcomes. The Moria M2 head 90, especially in LASIK-operated eyes, does not cut thinner flaps compared to the head 130. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] The treatment of uveal melanoma with iodine plaque brachytherapyACTA OPHTHALMOLOGICA, Issue 2009T KIVELÄ Purpose To provide an overview of managing uveal melanoma (UM) with iodine brachytherapy (IBT). Methods Personal experience of the author in using IBT since 1990. Results IBT is an effective option for managing a UM of any size, although it is mostly used for medium-sized tumours, preference being given to ruthenium brachytherapy (RBT) when the tumour is <5-6 mm thick and to transscleral local resection when thickness is >6 mm, especially when vision is good. IBT is also a safe alternative to enucleation of large UM >10 mm in thickness if the patient is keen to preserve the eye and motivated to accept eventual complications. The plaque is positioned over the UM with a 1-2 mm safety margin when using a collimated/rimmed plaque. Because of stray radiation, a safety margin is not mandatory when the plaque is non-collimated/non-rimmed. Otherwise, surgical technique does not differ from RBT. An advantage of IBT is that the radioactive seeds are separate from the plaque, allowing economical use of plaques of many different sizes and shapes and individual positioning of the seeds in a conformal way. A disadvantage is a short half-life; the seeds need to be changed every 6 months. The dose the author uses is 80 Gy to tumour apex, which is reduced on an individual basis to 60-70 Gy when the UM is very thick. Local tumour control rate is 90% and, paradoxically, not worse for large UM as compared to smaller ones. There are no unequivocal safety distances for avoiding radiation cataract, maculopathy and optic neuropathy, which are more or less frequent depending on the size and location of the UM. Conclusion IBT achieves good local tumour control of UM of all sizes, but preservation of vision is decidedly less frequent than after RBT, which is always given preference. [source] Analysis of national database for TEM resected rectal cancerCOLORECTAL DISEASE, Issue 9 2006S. Bach Objective:, Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to rectal resection for cancer. Patients benefit from rapid recovery, excellent function and stoma avoidance. Method:, The national TEM database has prospectively collated data from 21 centres since 1993. Details of preoperative evaluation, neoadjuvant therapy, technical aspects of surgery, postoperative complications, pathological staging, salvage, recurrence and survival have been recorded for 454 patients with rectal cancer, median follow-up 35 months. Results:, Intention was curative in 69%, for compromise in 22% and palliative in 5%. The morbidity and mortality of TEM was 17.2% and 1.5%. Neoadjuvant radiotherapy was administered in 8% of cases. Pathological staging: pT0 (1.8%), pT1 (52.9%), pT2 (32.8%), pT3 (9.9%) and pTx (3.1%). Margin positivity (< 1 mm) occurred in 20%; this was markedly stage dependent. 18 per cent received adjuvant radiotherapy while 13% progressed to major surgery. 5-year disease free survival was 77% pT1, 74% pT2 and 35% pT3 with local recurrence rates of 20%, 25% and 59% respectively. Age (P = 0.01), tumour area (P = 0.02) and pT stage (P = 0.07) predicted for relapse (Cox regression model). Conclusion:, TEM offers a safe alternative to major surgery curing three quarters of patients with pT1 disease. Although classical surgery must remain the standard of care we envisage future studies of TEM combined with adjuvant therapy. [source] Anaphylaxis during anaesthesia: diagnostic approachALLERGY, Issue 5 2007D. G. Ebo Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds. However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done. This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the diagnostic approach of this rare but potentially life-threatening complication. Apart from general principles about the diagnostic approach, history taking and importance of tryptase quantification, more specific confirmatory diagnostic procedures are organized on the basis of the major causes of perioperative anaphylactic reactions. [source] Legal piperazine-containing party pills-a new trend in substance misuseDRUG AND ALCOHOL REVIEW, Issue 3 2007JANIE SHERIDAN In this Harm Reduction Digest Sheridan, Butler, Wilkins and Russell address the emergent phenomenon of so-called ,legal party pills' which have become a significant drug issue in New Zealand and elsewhere. Although banned in a number of countries, they are currently legally available in New Zealand where they are marketed as ,safe' alternatives' to ,illicit' drugs often used in the dance scene such as MDMA and amphetamines. The authors describe the availability and use of these substances in New Zealand, summarize what is known about their effects, and speculate on harm reduction interventions and mechanisms of control and their possible sequelae. The paper provides a timely account of an emerging drug issue of relevance to harm reduction internationally. [source] | ||||||||||||||||||||||||||||