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The surgical management of obesity in Hong Kong has rapidly evolved over the past 20 years. Despite increasing public awareness and demand concerning bariatric and metabolic surgery, service models generally are not standardised across bariatric practitioners. Therefore, a working group was commissioned by the Hong Kong Society for Metabolic and Bariatric Surgery to review relevant literature and provide recommendations concerning eligibility criteria for bariatric and metabolic interventions within the local population in Hong Kong. The current position statement aims to provide updated guidance regarding the indications and contraindications for bariatric surgery, metabolic surgery, and bariatric endoscopic procedures.
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Cirurgia Bariátrica , Obesidade , Humanos , Cirurgia Bariátrica/normas , Cirurgia Bariátrica/métodos , Hong Kong , Obesidade/cirurgia , Adulto , Endoscopia/métodos , Endoscopia/normas , Sociedades Médicas , Obesidade Mórbida/cirurgiaRESUMO
AIMS: To determine the prevalence of neovascularity in the supraspinatus tendon of patients presenting with clinically painful unilateral rotator cuff tendinopathy (RCT) using conventional colour Doppler ultrasound (CDU), power Doppler ultrasound (PDU), and superb microvascular imaging (SMI). The association between Doppler findings and clinical scores was also assessed. METHODS: The bilateral supraspinatus of consecutive patients presented with unilateral RCT clinically were evaluated with grey-scale ultrasound (tendon thickening, heterogeneous echotexture, and hypoechogenicity), CDU, PDU, and SMI. The prevalence of neovascularity and grey-scale changes on duplex imaging techniques were analysed. The relationship between neovascularity on CDU, PDU, SMI, and pain/disability as determined using a visual analogue scale (VAS) and the Oxford Shoulder Score (OSS) were assessed. RESULTS: Fifty-nine patients (mean age 53 years, 39 women) were recruited. Of the symptomatic supraspinatus tendons, 42.4% (25/59) demonstrated neovascularity on SMI, compared to 6.8% (4/59) on PDU and 5.1% (3/59) on CDU. Of the asymptomatic supraspinatus tendons, 5.1% (3/59) depicted neovascularity on SMI but not on conventional Doppler techniques. SMI showed a significant correlation with the VAS (r2 = 0.560, p<0.001) and OSS (r2 = 0.62, p<0.001). PDU weakly correlated with the VAS and OSS (r2 = 0.312, p=0.016; r2 = 0.260, p=0.047, respectively) while CDU did not show a significant relationship. CONCLUSION: SMI is superior in demonstrating neovascularity and shows better correlation with pain and functional deficit compared to conventional Doppler in patients with painful RCT. SMI also showed vascularity to a lesser degree in the asymptomatic tendon. Further large-scale studies are needed to prove the diagnostic value of SMI in the assessment of RCT.
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Manguito Rotador , Tendinopatia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/epidemiologia , Dor , Prevalência , Manguito Rotador/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Tendinopatia/epidemiologia , Ultrassonografia Doppler em CoresRESUMO
BACKGROUND: Bariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here. METHODS: Population-based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006-2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co-morbidity Index (CCI) scores and co-morbidity rates were measured to compare changes in co-morbidities between surgically treated and control groups over 5 years. One-to-five propensity score matching was applied. RESULTS: Overall, 401 eligible surgical patients were matched with 1894 non-surgical patients. Direct medical costs were much higher for surgical than non-surgical patients in the index year (36 752 and 5788 respectively; P < 0·001) mainly owing to the bariatric procedure. The 5-year cumulative costs incurred by surgical patients were also higher (54 135 versus 28 603; P < 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5-year period, surgical patients had shorter length of stay in hospitals than non-surgical patients in year 2-5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P = 0·016). Costs of glucose-lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose-lowering medications in year 2 (973 versus 1395; P = 0.012). CONCLUSION: Bariatric surgery in obese patients with T2DM is expensive, but leads to an improved co-morbidity profile, and reduced length of hospitalization.
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Cirurgia Bariátrica/economia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Obesidade/economia , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus Tipo 2/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hong Kong/epidemiologia , Humanos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Estudos RetrospectivosRESUMO
AIM: Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes. METHODS: We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). RESULTS: In total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between self-management interventions and controls in post-intervention HbA1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision. CONCLUSIONS: Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes.
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Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Autogestão/métodos , Adolescente , Adulto , Índice de Massa Corporal , Depressão/psicologia , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/psicologia , Hemoglobinas Glicadas/metabolismo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Angústia Psicológica , Autocuidado , Autoeficácia , Adulto JovemRESUMO
Respiratory syncytial virus (RSV) may cause severe illness in cystic fibrosis (CF) children, but recommendations vary on prophylaxis. CARESS is a prospective registry of children who received palivizumab in 32 Canadian sites from 2005 to 2016. Demographic data were collected at enrollment and respiratory illness-related events recorded monthly. We reviewed respiratory illness hospitalization (RIH) and RSV hospitalization (RSVH) in CF children aged < 24 months versus those prophylaxed for standard indications (SI; prematurity, chronic lung disease [CLD] and congenital heart disease [CHD]), and complex medical disorders (CM). Of 23,228 children analyzed, 19,452 (83.8%) were SI, 3349 (14.4%) were CM, and 427 (1.8%) were CF. CF children were more likely to be Caucasian, heavier at birth and enrollment, and less likely to have a sibling or live in crowded conditions. CF children were similar to the other groups in daycare attendance, history of atopy, and exposure to smoking. RIH incidences were 4.3% (premature), 13.8% CLD, 11.5% CHD, 11.7% CM, and 6.8% CF. RSVH incidence in CF children was similar to that in the SI and CM groups: 1.1, 1.5, and 2.0% groups respectively. Cox regression analyses showed that compared to CF children, the HRs for RSVH in SI (HR 2.0 95% CI 0.5-8.3, p = 0.3) and CM (HR 2.4, 95% CI 0.6-9.8, p = 0.2) did not differ. CF children are equally at risk for RSVH relative to those prophylaxed for other indications. Pending robust evidence from prospective trials, palivizumab could perhaps be considered in the interim, for young CF patients born early during the RSV season with evidence of serious lung disease.
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Antivirais/uso terapêutico , Fibrose Cística/patologia , Palivizumab/uso terapêutico , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vírus Sincicial Respiratório Humano/efeitos dos fármacos , Canadá/epidemiologia , Pré-Escolar , Feminino , Cardiopatias Congênitas , Humanos , Lactente , Masculino , Estudos Prospectivos , Sistema de Registros , Infecções por Vírus Respiratório Sincicial/tratamento farmacológicoRESUMO
AIM: To report the authors' experience of focal nodular haematopoietic marrow hyperplasia (FNHMH) and diffuse haematopoietic marrow hyperplasia (DHMH) clinically masquerading as skip, distant, or disseminated metastasis in seven patients with underlying malignant neoplasms. MATERIALS AND METHODS: Five patients with FNHMH and two with DHMH mistaken radiologically as skip and disseminated metastasis, respectively, were compared and contrasted with four patients with osteosarcomas and two with chondrosarcomas harbouring skip metastasis, noting the temporal relationship with their haematological profile. RESULTS: FNHMH and DHMH were undetectable by plain radiography and computed tomography (CT) except one showing subtle sclerosis on CT. They showed either isointense or hyperintense, but not hypointense, attenuation at T1-weighted imaging, and all showed hyperintense attenuation at T2-weighted MRI relative to skeletal muscle. Of the five patients who underwent bone scintigraphy, one showed mildly increased uptake, and one out of two showed markedly increased 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-positron-emission tomography (PET) uptake. The rates for sarcoma skip metastasis by plain radiography, CT, MRI, and bone scintigraphy were 40%, 66.7%, 100%, and 66.7%, respectively. At MRI, 60% showed hypointense and 40% isointense attenuation at T1-weighted, 80% hyperintense and 20% hypointense attenuation at T2-weighted imaging. Combined FDG-PET and CT, which was performed in only one patient, failed to show the skip metastasis. Not every patient with FNHMH or DHMH received granulocyte colony-stimulating factor (GCSF), but all had low or falling haemoglobin levels, which may thus be the prime cause for HMH. CONCLUSIONS: Due to overlapping radiological features, FNHMH and DHMH are great radiological mimics of malignancy. In some cases, needle biopsy is required for their definitive differentiation.
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Neoplasias da Medula Óssea/sangue , Neoplasias da Medula Óssea/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Neoplasias Hematológicas/sangue , Neoplasias Hematológicas/diagnóstico por imagem , Hemoglobinas/análise , Adolescente , Adulto , Criança , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Reações Falso-Negativas , Neoplasias Hematológicas/complicações , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeAssuntos
Doenças Musculoesqueléticas , Lesões do Manguito Rotador , Tendinopatia , Humanos , Manguito Rotador/diagnóstico por imagem , Prevalência , Tendinopatia/diagnóstico por imagem , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/epidemiologia , Ultrassonografia DopplerRESUMO
BACKGROUND: Radiofrequency ablation (RFA) is an emerging treatment for primary aldosteronism owing to aldosterone-producing adenoma. Whether RFA could be an alternative treatment to laparoscopic adrenalectomy is unknown. METHODS: This was a retrospective comparative study in patients with aldosterone-producing adenoma undergoing either laparoscopic adrenalectomy or CT-guided percutaneous RFA between 2004 and 2012. Short-term outcomes and long-term resolution rates of primary aldosteronism (normalized aldosterone to renin ratio), hypokalaemia and hypertension (BP lower than 140/90 mmHg without antihypertensive medical therapy) were evaluated. RESULTS: Some 63 patients were included, 27 in the laparoscopic adrenalectomy group and 36 in the RFA group. RFA was associated with shorter duration of operation (median 12 versus 124 min; P < 0·001), shorter hospital stay (2 versus 4 days; P < 0·001), lower analgesic requirements (13 of 36 versus 23 of 27 patients; P < 0·001) and earlier resumption of work (median 4 versus 14 days; P = 0·006). Morbidity rates were similar in the two groups. With median follow-up of 5·7 (range 1·9-10·6) years, resolution of primary aldosteronism was seen in 33 of 36 patients treated with RFA and all 27 patients who had laparoscopic adrenalectomy (P = 0·180). Hypertension was resolved less frequently after treatment with RFA compared with laparoscopic adrenalectomy (13 of 36 versus 19 of 27 patients; P = 0·007). Hypokalaemia was resolved in all patients. CONCLUSION: For patients with aldosterone-producing adenoma the efficacy of resolution of primary aldosteronism and hypertension was inferior after treatment with RFA compared with laparoscopic adrenalectomy.
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Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Laparoscopia/métodos , Terapia a Laser/métodos , Adenoma/diagnóstico , Adenoma/metabolismo , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/metabolismo , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Aldosterona/metabolismo , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Hipertensão/cirurgia , Tempo de Internação/estatística & dados numéricos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
Replacing Ir with Rh in a CoIr system possessing negative uniaxial magnetocrystalline anisotropy (K u ) substantially reduces its magnetic damping and coercivity by more than half while retaining its high negative K u . Moreover, a higher saturation magnetization (M s ) and more isotropic coercivity are achieved. Such material development makes it particularly suitable for use as the soft underlayer (SUL) of magnetic recording media for reducing noise, and as the oscillation layer of a spin-torque oscillator (STO) for achieving higher oscillation frequency, larger AC magnetic field and lower driving current, which can be readily integrated with the current recording head for microwave-assisted magnetic recording. Finally, we recommend a composite free layer by coupling CoIr with a spin polarizer (Co or Co/Cu/Co) for the enhancement of the spin-polarization rate and, therefore, the improvement of STO efficiency. These could pave the way for CoIr-based materials to be implemented in devices requiring a negative Ku with low damping and high 'softness', such as oscillators.
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OBJECTIVES: To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants' attitudes to weight management. DESIGN: Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective. SETTING: Primary care clinics located in northern and central Singapore. PARTICIPANTS: 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3-44.0kg/m2) and type 2 diabetes for 6 years or less. RESULTS: The main themes - everyday life, people around me and within me - pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change. CONCLUSION: An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual's efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants' stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.
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Diabetes Mellitus Tipo 2 , Obesidade , Sobrepeso , Pesquisa Qualitativa , Humanos , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Singapura , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Obesidade/psicologia , Sobrepeso/psicologia , Entrevistas como AssuntoRESUMO
BACKGROUND: The aim of this study was to report on the 5-year survival outcomes of patients with resectable esophageal carcinoma who were treated by definitive chemoradiotherapy (CRT) or standard esophagectomy. PATIENTS AND METHODS: Between July 2000 and December 2004, 81 patients with resectable squamous cell carcinoma of the mid- or lower thoracic esophagus were randomized to receive esophagectomy or definitive CRT. The primary outcome was the overall survival and secondary outcomes included disease-free survival, morbidities and mortalities. RESULTS: Forty-five patients received esophagectomy and 36 patients were treated by definitive CRT. The overall 5-year survival favors CRT but the difference did not reach statistical significance (surgery 29.4% and CRT 50%, P=0.147). A trend to improved 5-year survival was observed for patients suffering from node-positive disease (P=0.061). The 5-year disease-free survival also showed a trend to significance favoring CRT (P=0.068), particularly for patients suffering from node-positive disease (P=0.017). Both the stage of the disease and albumin level were significant predictors to mortality and disease-free survival. CONCLUSIONS: Definitive CRT for squamous esophageal carcinoma resulted in comparable long-term survival to surgery. Further large-scale studies would be required to further investigate the role of CRT in node-positive patients. Clinicaltrials.gov identifier: NCT01032967.
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Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Análise de Sobrevida , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Neoplasias Esofágicas/cirurgia , Humanos , Estudos ProspectivosRESUMO
Achalasia is a rare primary motility disorder of esophagus; treatments include endoscopic balloon dilatation (EBD) and laparoscopic Heller's cardiomyotomy (LC). This study compared EBD versus LC for treatment of achalasia with focus on quality of life (QoL) and prevalence of post-treatment gastroesophageal reflux disease. This was a retrospective cohort study of all patients diagnosed with achalasia older than 16 treated with either EBD or LC from January 1998 to April 2008. Patients' demographic data, comorbidities, postintervention GERD symptoms, QoL, recurrence of dysphagia, reintervention rate, hospital stay, and time to resumption of diet were collected. Sixty-eight patients were recruited into the study (EBD n= 50; LC n= 18). A significant improvement in QoL was found in patients undergoing LC (0.917 vs. 0.807, P= 0.006). A higher proportion of patients treated with EBD developed post-treatment gastroesophageal reflux symptoms (60.5% vs. 43.8%) when compared with LC, although statistically insignificant (P= 0.34). Patients treated with balloon dilatation had a greater percentage of recurrence of dysphagia (55.1% vs. 26.7%; P= 0.235) and need of reintervention (42.1% vs. 9.1%; P= 0.045). However, these patients had a shorter median hospital stay (1d [range 0-4]) and earlier resumption of diet (0d [range 0-3]). Although EBD is associated with a quicker perioperative recovery, LC accomplished a better QoL, lower incidence of recurrence of dysphagia, and need of reintervention after treatment for achalasia.
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Cárdia/cirurgia , Cateterismo/métodos , Transtornos de Deglutição/prevenção & controle , Acalasia Esofágica/cirurgia , Esofagoscopia/métodos , Laparoscopia/métodos , Qualidade de Vida , Adulto , Estudos de Coortes , Dieta , Dilatação/métodos , Acalasia Esofágica/psicologia , Acalasia Esofágica/terapia , Feminino , Seguimentos , Refluxo Gastroesofágico/etiologia , Hospitalização , Humanos , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Bariatric surgery has recently been considered as an option for treatment of type 2 diabetes mellitus (T2DM). We assessed the effect of laparoscopic gastric banding and laparoscopic sleeve gastrectomy in a cohort of 39 T2DM Chinese patients with body mass index (BMI) over 30 kg/m(2) . Their mean body weights and BMI before surgery were 108 kg and 40 kg/m(2) , respectively, and 18 patients (46%) had suboptimal diabetic control (HbA1c >7%). After a mean follow-up of 27 months, 4 of 11 insulin-dependent patients (36%) were able to stop their insulin therapy, and 18 patients (46%) achieved remission of T2DM (HbA1c <6.5% without the use of medication). Glycaemic control remained poor in only nine other patients (27%). Logistic regression analysis showed that a short history of T2DM and high BMI could predict remission of diabetes after restrictive procedures. Our results suggest that restrictive surgery can significantly improve glycaemic control in obese T2DM patients.
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Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia , Gastroplastia , Obesidade Mórbida/cirurgia , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , China/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Seguimentos , Gastrectomia/métodos , Gastroplastia/métodos , Hemoglobinas Glicadas/metabolismo , Humanos , Modelos Logísticos , Masculino , Obesidade Mórbida/sangue , Obesidade Mórbida/epidemiologia , Indução de Remissão , Resultado do Tratamento , Redução de PesoRESUMO
Introduction: Flexor tendon repair is challenging mainly due to the need to balance between a strong repair technique, ease of tendon gliding and early mobilisation to prevent adhesions while preventing tendon rupture. While different countries have different preferences in repair techniques, core sutures and suture types, there is still no study in Malaysia regarding our preference and whether we are following the current evidence. Materials and methods: We performed a survey with a standard questionnaire distributed during our annual national orthopaedic meeting in 2019. The standard questionnaire consisted of 24-objective multiple-choice questions concerning the treatment of flexor tendon injury were distributed with consent. A total of 290 questionnaires that were filled out correctly were included in this study. Results: The majority of respondents preferred the Modified Kessler technique (n=96, 33.1%) followed by the Adelaide technique (n=81, 27.9%) and Double Modified Kessler (n=45, 15.5%). However, for the number of core strands in the repair, the majority utilised the 4-strand (n=203, 70%), followed by 2-strand (n=34, 11.7%) and 6-strand (n=21, 7.2%). The majority utilised Prolene sutures (n=259, 89.3%) with a suture size of 4/0 (n=157, 54.1%). For rehabilitation, 56.9% (n=165) preferred early passive motion, 27.6% (n=80) early active motion and 14.8% (n=43) would strictly immobilise. Conclusion: There is still no consensus as to the best technique; however, the aim of tendon repairs is still the same around the world. It would be helpful to know our preferences to improve our current practice and outcomes following these common flexor tendon injuries in hand.
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INTRODUCTION: Distal radius fracture (DRF) is the most common orthopaedic injury with a reported incidence of 17.5%. It is commonly seen in young males and elderly females. Over the last two decades, there is an increasing tendency to treat DRF surgically by open reduction and internal fixation (ORIF) with plate and screws owing to improved device design, better fixation and operative technique. The purpose of this study was to evaluate the demographic characteristics, type and method of fixation, and outcome in all surgically treated DRF cases from 2014 to 2018 in a university hospital. MATERIALS AND METHODS: A retrospective review of all surgically treated DRF cases with one year follow-up in a tertiary hospital in Malaysia was done. Patients who left the follow-up clinic before one-year post-surgery or before fracture union were excluded. A total of 82 patients with 88 DRF were finally included into the study and outcome in terms of union time and need of multiple surgeries were analysed along with the predictors. RESULTS: In this study, mean age of the patient was 46.2 years. Motor vehicle accident was the commonest cause of the fracture and AO Type C fracture was the commonest fracture type. Seventeen (19.3%) out of 88 fractures were compound fracture. Open reduction and internal fixation with volar plate was the most common surgical technique done in this series (93.2%). Three (3.5%) out of 88 fractures required multiple surgeries and eighty-three (94.3%) DRF cases were united before nine months of the surgery in this study. There was statistically significant association between clinical type of the fracture and the union time (p-value <0.05). CONCLUSION: There was a 1.7:1 male-female ratio with AO-C fracture being the most common type of fracture. The most common method of fixation was ORIF with volar locked plate. Patients with closed fractures have a higher rate of union compared to open fractures at nine months.
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A newly designed insulated angulotome was evaluated in a series of patients in whom biliary cannulation using conventional methods had failed and who required precut sphincterotomy. The new device consists of an insulated glass tip to prevent excessive electrocautery flow, and angulation to facilitate elevation of the papillary roof on cutting. A prospective series of patients with cholangitis or obstructive jaundice with failed biliary cannulation were recruited. The success of cannulation and complications following endoscopic retrograde cholangiopancreatography were analyzed. A total of 13 patients underwent precut sphincterotomy using the insulated angulotome. The immediate success of gaining biliary access after failed cannulation was 100 %. The mean size of the common bile duct on ultrasonography was 8.1 mm. The mean time to achieve biliary cannulation was 9 minutes 4 seconds, and there was no perforation or bleeding. This case series showed that precut sphincterotomy with the insulated angulotome can be safely performed without major complications.
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Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Esfinterotomia Endoscópica/instrumentação , Cateterismo , Ducto Colédoco/cirurgia , HumanosRESUMO
Range and Doppler tracking data from Mariners 6 and 7 have been used to obtain values for the ratio of the mass of the earth to that of the moon which are in substantial agreement with those determined from other Mariner and Pioneer spacecraft. There is an inconsistency of about 0.004 percent in values for the mass of the moon determined from lunar trajectories. A gravitational constant for Mars of 42,828.48 +/- 1.38 cubic kilometers per second per second, obtained on the basis of data collected during the 5 days prior to the closest approach of Mariner 6 to Mars, is in excellent agreement with the result obtained by Null from tracking data of Mariner 4.
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Preliminary analyses of Doppler data from Pioneer 10 during its encounter with Jupiter indicate that the mass of Io is about 20 percent greater than previously thought and that Io's mean density is about 3.5 grams per cubic centimeter. A determination of the dynamical flattening of Jupiter (a - b)/a (where a is the semimajor axis and b is the semiminor axis) is found to lie in the neighborhood of 0.065, which agrees with the value determined from satellite perturbations.
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Significantly improved values of the zonal gravity harmonic coefficients J(39) J(4), and J(6) of Jupiter have been obtained from a preliminary analysis of Pioneer 11 spacecraft Doppler data taken while the spacecraft was near Jupiter. The new results, which will have an important application as boundary conditions for theoretical models of Jupiter's interior. are consistent with a planet in hydrostatic equilibrium.