Between April (between + april)

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Selected Abstracts

Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma

Norihito Soga
Objectives: To evaluate the efficacy of adjuvant platinum based chemotherapy in upper urinary tract urothelial cancer following surgical resection in terms of survival benefit and inhibition of bladder cancer recurrence. Methods: Between April 1986 and August 2005, a total of 132 patients with a diagnosis of upper urinary tract urothelial cancer underwent radical nephroureterectomy with cuff of bladder at our department. A total of 46 patients (13 with pT2pN0M0 and 33 with pT3 pN0M0 transitional cell carcinoma without prior bladder cancer) were enrolled. Patients with locally advanced disease were divided into two groups: the adjuvant chemotherapy group (24 patients) who received adjuvant methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC) and the non-adjuvant chemotherapy group who did not receive adjuvant M-VAC (22 patients). Results: There were no statistically significant differences in patient characteristics or 10-year survival between the two groups. The recurrence rate in the non-adjuvant chemotherapy group was significantly higher than in the adjuvant chemotherapy group (log-rank test, P < 0.0001). Only non-adjuvant chemotherapy was a significant and independent risk factor (hazard ratio 6.97) for the development of intravesical recurrence (P < 0.01). Conclusion: Adjuvant M-VAC is an important optional adjuvant therapy and can prevent recurrent bladder tumors following surgery for upper urinary tract transitional cell carcinoma. To determine whether adjuvant chemotherapy has further benefit, a randomized study would be needed. [source]

Efficacy and safety of laparoscopic surgery for pheochromocytoma

Abstract Objective: Laparoscopic surgery for primary aldosteronoma and Cushing's syndrome is well established. We report on our experiences with laparoscopic adrenalectomy for pheochromocytoma, and assess the efficacy and safety of the laparoscopic approach. Methods: Between April 1998 and April 2003, a total of 23 patients underwent laparoscopic adrenalectomy for pheochromocytoma at Chiba University Hospital and Yokohama Rosai Hospital, Japan. We compared the surgical outcomes of these patients with those of 106 patients with adrenal tumors due to other pathologies who underwent laparoscopic adrenalectomy during the same period. Results: The mean tumor size of pheochromocytoma was 4.96 cm. Mean operative time was 192.7 min, and mean estimated blood loss was 130 mL. Neither mean operative time nor mean estimated blood loss was greater for patients with pheochromocytoma. Intraoperative hypertension (systolic blood pressure > 180 mmHg) occurred in 39.1% (9/23) of patients with pheochromocytoma. During the follow-up period, there were no mortalities or recurrences of endocrinopathy. Conclusions: Laparoscopic adrenalectomy for pheochromocytoma is a safe and minimally invasive procedure. [source]

Repair of Flail Leaflet of the Tricuspid Valve by a Simple Cusp Remodeling Technique

Xiubin Yang M.D.
We try to present an alternative method and midterm results. Methods: Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring. Results: All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 12.5 mm to a mean of 23.6 5.3mm (p < 0.01). Mean follow up was 50 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well. Conclusion: The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae. [source]

Association between central venous pressure and blood loss during hepatic resection in 984 living donors

Background: Although low central venous pressure (CVP) anesthesia has been used to minimize blood loss during hepatectomy, the efficacy of this technique remains controversial. We therefore assessed the association between blood loss and CVP during hepatic resection, and examined significant determinants associated with intraoperative hemorrhage during hepatectomy in living donors. Methods: Between April 2004 and April 2008, 984 living donors who underwent a hepatic resection were assessed retrospectively. Univariate and multivariate analyses were performed to explore the relationships between intraoperative blood loss and several variables including CVP. Results: The mean intraoperative blood loss was 691.3 365.5 ml. Only four donors required packed red blood cell transfusions (mean, 1.5 U). The mean duration of hepatic resection was 92.1 26.3 min. The mean, maximum, and minimum values of CVP measured during hepatectomy were 4.6 1.7, 5.3 1.8, and 4.0 1.8 mmHg, respectively, and were not significantly correlated with intraoperative blood loss. On multivariate analysis, predictors of hemorrhage were liver fatty change, gender, and body weight, but none of the mean CVP, surgeons, anesthesiologists, anesthesia duration, resected liver volume, hepatectomy type, systolic blood pressure, heart rate, or body temperature were significant. Conclusions: CVP during hepatic resection was not associated with intraoperative blood loss in living liver donors, suggesting that CVP may not be an important factor in predicting blood loss during hepatectomy in healthy subjects. [source]

Long-term treatment of localized gastric marginal zone B-cell mucosa associated lymphoid tissue lymphoma including incidence of metachronous gastric cancer

Shouko Ono
Abstract Background and Aim:, According to a few recent reports on the long-term clinical outcome of gastric marginal zone B-cell mucosa associated lymphoid tissue lymphoma (MALT lymphoma); localized gastric MALT lymphoma generally has a favorable prognosis. However, the risk of metachronous gastric cancer has not been evaluated. In this study, we analyzed long-term outcomes of localized gastric MALT lymphoma including the incidence of metachronous gastric cancer. Methods:, Between April 1996 and May 2008, 60 patients (31 men and 29 women; mean age 58.1 years) with localized gastric MALT lymphoma (stage I and II1 according to Lugano classification) were analyzed retrospectively. Results:, Forty-eight patients (82.6%) achieved complete remission by eradication therapy. Radiation therapy was conducted on eight patients as second-line treatment, and all of them achieved remission. The median follow-up period was 76 months (range, 12,157 months). One patient had local relapse after remission for 5 years and three patients developed early gastric cancer without recurrence of lymphoma (5%). All of the three gastric cancers appeared in the same areas where MALT lymphoma had been eradicated. Conclusion:, Eradication therapy and radiation therapy for localized gastric MALT lymphoma have a favorable long-term outcome, though regular follow-up endoscopy should be performed for detecting metachronous early gastric cancer. [source]

Long pediatric colonoscope versus intermediate length adult colonoscope for colonoscopy

Yu-Hsi Hsieh
Abstract Background:, Controversy exists on how the length and diameter of colonoscopes affect the quality of colonoscopy. The aim of this study was to compare a long pediatric colonoscope with an intermediate length adult colonoscope with regards to completion rate and cecal intubation time. Whether either scope may be more efficient in any subgroups was also investigated. Methods:, Asymptomatic patients admitted to the physical check-up department of Buddhist Dalin Tzu Chi General Hospital were included. A single endoscopist performed all of the colonoscopic examinations under sedation. Consecutive patients were randomized to undergo colonoscopy with either intermediate length adult colonoscope (CF-240I) or long pediatric colonoscope (PCF-240L). The success rate and time required to reach cecum were compared between the two groups. Results:, Between April 2005 and February 2006, a total of 918 patients were enrolled. Incomplete colonoscopy occurred in 21 (2.3%) cases (14 in the CF-240I group and seven in the PCF-240L group, P > 0.1). The overall cecal mean insertion time was 6.00 3.66 min. There was no significant difference between the CF-240I and PCF 240L groups with regard to the cecal intubation rate (96.9% vs 98.5%, P = 0.18), the need for abdominal pressure (71.7% vs 73.4%, P = 0.55) and change of position (13.5% vs 11.5%, P = 0.37). However, the cecal intubation time was shorter in the CF-240I group (5.75 3.18 vs 6.26 3.30 min, P = 0.02). Subgroup analysis by sex, age, and body mass index showed comparable outcomes between the two groups except that the cecal intubation times were significantly shorter in the CF-240I group when only men (4.78 2.57 vs 5.50 2.93 min, P < 0.01) or those younger than 50 years (5.50 2.90 vs 6.25 3.68 min, P = 0.02) were considered. Conclusion:, Cecal intubation time is shorter in patients examined with an intermediate length adult colonoscope, mainly in the subgroups of men and those younger than 50 years of age. [source]

Prevalence and genotype distribution of hepatitis C virus among apparently healthy individuals in Mongolia: a population-based nationwide study

Oidov Baatarkhuu
Abstract Background and Aims: Hepatitis C virus (HCV) is one of the major causes of liver cirrhosis and hepatocellular carcinoma (HCC) in Mongolia. However, there are no data concerning nationwide prevalence of HCV infection in Mongolia. We intended to investigate the population-based prevalence of HCV infection and genotype distribution among 1512 apparently healthy individuals in this country. Methods: Between April 2003 and December 2005, sera from 1512 residents of Ulaanbaatar and 12 provinces were collected by two-stage cluster random sampling, and anti-HCV was tested. Anti-HCV-positive samples were tested for HCV RNA by reverse transcription polymerase chain reaction, and HCV genotype was determined. Results: The mean age of the subjects was 46.217.8 years, and 812 (53.7%) were male. Overall, the prevalence of anti-HCV was 15.6% (236/1512) and HCV RNA was detected in 167 subjects (11.0%), with the most common genotype being 1b (165/167, 98.8%). When the HCV RNA-positive subjects were categorized by decade of age, the prevalence in each age group was as follows: 2.5% in subjects ,10 years of age, 4.5% in teens, 10.1% in 20's, 12.5% in 30's, 24.2% in 40's, 29.0% in 50's and 32.6% in subjects ,61 years of age. The seroprevalence of anti-HCV in a risk group, nurses, was not significantly different from the general population in each decade of age (P>0.05). Conclusions: Approximately 11.0% of apparently healthy population had detectable HCV RNA in Mongolia, and the predominant genotype of HCV was 1b. Preventive and therapeutic strategies for chronic hepatitis C are urgently warranted in this HCV-endemic area. [source]

Posterior pedicle screws combined with shortening and release techniques for lumbar and thoracolumbar adolescent idiopathic scoliosis

Su-xi Gu MD
Objective:, To prospectively evaluate the clinical and radiographic effects of posterior surgery with wide posterior shortening release and segmental pedicle screws techniques in a consecutive group of patients with thoracolumbar /lumbar adolescent idiopathic scoliosis. Methods:, Between April 2002 and July 2005, 114 patients (86 women and 28 men) were enrolled in this study. There were 72 Lenke type 5, 32 Lenke type 6, and 10 Lenke type 3C curves. Radiographic parameters such as coronal plane Cobb angle; lordosis angle; lowest instrumented vertebrae (LIV) angulation; and the distances from the central sacral vertical line (CSVL) to the LIV, to the apical vertebra and to the C7 plumb line, were analyzed. Complication rates were also recorded during follow-up. Results:, The average coronal correction was from 61 to 13 (78.6%). In the sagittal plane, lumbar lordosis was normalized from 36 with a wide range (23,67) to 42 with a normal range (34,55). The LIV had 79% correction of coronal angulations. The center sacral line to LIV was improved from 2.3 cm to 0.5 cm, apex to center sacral line from 5.0 cm to 1.6 cm, and CSVL from 2.7 cm to 0.8 cm. A total of 1460 pedicle screws were placed safely, average 9.6 levels (5,14) were fused. The patients were followed up for an average of 30 months (range, 12,50). There was excellent maintenance of correction at final follow-up. Conclusion:, Wide posterior release and segmental pedicle screw instrumentation has excellent radiographic and clinical results with minimal complications. [source]

Pilot Study of Sexual Dysfunction Following Abdominal Aortic Aneurysm Surgery

MRCSI, Vincent Koo MBBCh
ABSTRACT Introduction., The complication of sexual dysfunction as a quality of life (QoL) component after abdominal aortic aneurysm (AAA) surgery in men is poorly studied. Aims., To investigate the prevalence of sexual dysfunction and to highlight the importance of discussing this issue with patients undergoing AAA repair. Main Outcome Measures., The self-reported sexual dysfunction prevalence pre- and postoperatively, the effects on sexual QoL, and the postoperative Sexual Health Inventory for Men (SHIM) scores. Methods., Between April 1999 and July 2002, a questionnaire-based study, including the SHIM, was conducted on male patients 1,2 years after their elective open (EO) and rupture open (RO) or endovascular repair (EVAR) AAA repair. Demographics, risk factors for sexual dysfunction, sexual history, and postoperative sexual QoL data were obtained. Results., Out of 142 alive male patients surveyed, 56 (40%) patients responded (26 EO, 21 EVAR, and 9 RO repair). The mean age was 69, 73, and 70 years, respectively, and 65%, 66%, and 66%, respectively, admitted to be sexually active postoperatively. The self-reported sexual dysfunction prevalence preoperatively was 27% (EO), 63% (EVAR), and 45% (RO); and postoperatively was 58%, 76%, and 67%, respectively. Detection using SHIM was higher at 70%, 95%, and 78%, respectively. There was a significantly greater increase in the postoperative prevalence of sexual dysfunction in the EO group than in the EVAR group (P < 0.05, ,2). The sexual QoL was worsened postoperatively in all groups: 53% (EO), 75% (EVAR), and 50% (RO); but only one-third of EO and EVAR patients, and none in RO patients, would seek treatment for their sexual dysfunction. Conclusion., There was a negative impact on the sexual QoL in all groups after surgery, and a significantly higher proportion of patients experienced deterioration in sexual QoL following EO surgical repair. Our results demonstrate the need for a prospective study. Koo V, Lau L, McKinley A, Blair P, and Hood J. Pilot study of sexual dysfunction following abdominal aortic aneurysm surgery. J Sex Med 2007;4:1147,1152. [source]

Implantation of ethylene vinyl alcohol copolymer for faecal incontinence management

Jacqueline H. Stephens
Abstract Purpose:, The primary objectives of this trial were to evaluate the safety and feasibility of treatment and to gain a preliminary indication of the effectiveness of ethylene vinyl alcohol injections into the anal sphincters of faecally incontinent patients. Methods:, Between April 2004 and February 2006, we conducted a prospective, single-arm, procedure optimization study of ethylene vinyl alcohol injections in 21 subjects with well-characterized faecal incontinence and an intact external anal sphincter at two Australian hospitals. Results:, There was a significant decrease in the Cleveland Clinic Florida Faecal Incontinence Score (CCFFIS) (P= 0.0005) and the Faecal Incontinence Severity Index score (P= 0.005) after treatment. At 12 months post-treatment, the mean CCFFIS had decreased by 37% (P= 0.0021), and 47% of subjects had a ,50% improvement in CCFFIS. There were significant improvements in embarrassment (P= 0.0455) and coping/behaviour (P= 0.0056) domains of the Faecal Incontinence Quality of Life. At 12 months, the mean anal canal length had increased by 29% (P= 0.066), with 40% of patients demonstrating increases of 50% or more. There were no further improvements following retreatment. Conclusions:, Ethylene vinyl alcohol injection into the anal intersphincteric plane is feasible and well tolerated. Improvement in faecal incontinence compared with baseline was seen. Retreating initial non-responders was not successful. [source]

Transcatheter closure of perimembranous ventricular septal defects using the amplatzer membranous VSD occluder: Immediate and midterm results of an international registry

Ralf Holzer MD
Abstract Objective: To report the immediate and midterm results of transcatheter closure of perimembranous ventricular septal defect (PmVSD) using the Amplatzer membranous VSD occluder (AMVSD). Methods: Between April 2002 and August 2004, 100 patients underwent an attempt of percutaneous device closure of PmVSD using the AMVSD in 24 international centers. The median age was 9.0 years (0.7,58 years) and the median weight was 27.5 kg (7,121 kg). Results: A device was successfully deployed in 93/100 (93%) patients. Reasons for procedural failure were an increased gradient across the left ventricle outflow tract in one patient, aortic regurgitation in 2 patients, and inability to securely position the device in 4 patients. The median VSD size by TEE was 7.0 mm (1.5,13 mm), median device size 10 mm (4,16 mm) and median fluoroscopy time 22.1 min (8.9,96.0 min). Weight below 10 kg (P = 0.0392), inlet extension of the VSD (P = 0.0139) and aortic cusp prolapse into the VSD (P = 0.0084) were significantly associated with a lower procedural success. Patients have been followed up for a median of 182 days (1,763 days). There were no procedure-related deaths. Complications were encountered in 29/100 (29%) patients, including rhythm or conduction anomalies in 13 patients (two with complete heart block requiring permanent pacemaker implantation), new or increased aortic (9 patients) or tricuspid (9 patients) regurgitation, most of which were classified as trivial or mild. Patients with a weight below 10 kg had a significantly higher incidence of adverse events than patients with a weight above 10 kg (58.3% versus 25.0%, P = 0.0285). Immediately after device release complete closure of the defect was present in 54/93 (58.1%) patients, increasing to 46/55 (83.6%) patients at 6-months follow-up (P = 0.0012). Left ventricle end-diastolic diameter decreased from a median of 44 mm prior to device closure to a median of 39 mm at 6-months postprocedure (P = 0.0015). Conclusion: Closure of PmVSDs using the AMVSD occluder is safe and effective. However, longer follow-up period is warranted prior to the wide spread use of this device. 2006 Wiley-Liss, Inc. [source]

Dyslipidemia in patients with angiographically confirmed coronary artery disease,an opportunity for improvement

Sanjaya Khanal M.D.
Abstract Background: There are few data about lipid profiles in unselected patients with angiographically confirmed coronary artery disease (CAD). Hypothesis: The study was undertaken to investigate the demographics, clinical characteristics, angiographic findings, and baseline lipid status of 1,000 consecutive unselected patients with angiographically confirmed CAD. Methods: Between April 2001 and July 2002, we obtained informed consent and prospectively collected clinical characteristics, fasting lipid profiles, and angiographic results from 1,000 sequential patients with CAD confirmed by angiography. Results: In these patients with confirmed CAD, 78% had history of hyperlipidemia. Although 62% were receiving lip-id-lowering therapy, only 46% had a low-density lipoprotein target of < 100 mg/dl, and only 20% had achieved all four National Cholesterol Education Program-recommended lip-id targets. Conclusions: Better strategies to ensure optimal lipid levels are required. One such method using computerized workflow is being evaluated in this population. [source]

Laparoscopic resection of diverticular fistulae: a 10-year experience

A. H. Engledow
Abstract Objective, Until recently the laparoscopic approach was reserved for uncomplicated diverticular disease. We show that fistulating diverticular disease can be resected safely, with good clinical outcome via a laparoscopic approach. Method, Between April 1994 and May 2005, 31 consecutive patients [17 male, median age of 63 years (range 40,85)], underwent attempted laparoscopic resection for diverticular fistulae. Patient data were prospectively recorded. Results, There were 22 colovesical and nine colovaginal fistulae. The median operative time was 150 min (range 60,310) and the median postoperative stay was 7 days (range 3,21). Conversion to an open procedure was required in nine of 31 patients (29%). This rate fell to 10% in cases performed after April 2000. There were two nonsurgically related postoperative deaths. Both occurred in the converted group. At 3 months follow-up, two patients complained of frequency of stools, which settled by 6 months. To date there has been no recurrence of symptomatic diverticulosis or fistulation. Conclusion, Totally laparoscopic resection for diverticular fistulae is safe and feasible. Fistulae should not be considered as a contraindication to laparoscopic resection for an experienced laparoscopic surgeon. [source]