Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China.

OBJECTIVE: Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population. DESIGN: Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis. SETTING: Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit. PATIENTS, PARTICIPANTS: Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents. RESULTS: Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme. CONCLUSIONS: Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

Strategies to optimize the performance of Robotic-assisted laparoscopic hysterectomy.

A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL(®) Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary -significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy.

Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery.

OBJECTIVE: The primary aim of this study was to report on the prevalence of perioperative complications associated with reconstructive pelvic surgery. A secondary aim was to identify risk factors predictive of perioperative complications in this population. STUDY DESIGN: A retrospective chart review was performed of 100 consecutive cases of reconstructive pelvic surgery. Statistical analysis included descriptive statistics and logistic regression. RESULTS: The prevalence of perioperative complications was 46%, including 13 intraoperative complications and 33 postoperative complications. The readmission rate for complications was 15%. The number of procedures per patient was an independent risk factor for intraoperative blood loss (P <.0038). Intraoperative estimated blood loss in turn was an independent risk factor for perioperative complications (P <.0001). CONCLUSIONS: Perioperative complications associated with reconstructive pelvic surgery were increased relative to those associated with general gynecologic surgery. The number of procedures per patient and associated blood loss appeared to contribute to the increase in perioperative complications.

A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography.

BACKGROUND: A reliable model for predicting the outcome of primary cytoreductive surgery may be a useful tool in the clinical management of patients with advanced epithelial ovarian carcinoma. METHODS: Forty-one women with a preoperative computed tomographic (CT) scan of the abdomen and pelvis and a histologic diagnosis of Stage III or IV epithelial ovarian carcinoma following primary surgery performed by one of nine gynecologic oncologists were identified from tumor registry databases. All CT scans were analyzed retrospectively using a panel of 25 radiographic features without knowledge of the operative findings. Patient demographics, surgical findings and outcome, Gynecologic Oncology Group performance status, and pre-operative serum CA125 values were collected from patient medical records. Residual disease measuring < or = 1 cm in maximal diameter was considered an optimal surgical result. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each radiographic feature and clinical characteristic. Based on statistical probability of each factor predicting cytoreductive outcome, 13 radiographic features, in addition to performance status, were selected for inclusion in the final model. Each parameter was assigned a numeric value based on the strength of statistical association, and a total Predictive Index score was tabulated for each patient. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to predict surgical outcome. Statistical significance was evaluated using the Fisher exact test. RESULTS: Twenty of 41 patients (48.8%) underwent optimal cytoreduction to /= 2 cm), bowel mesentery involvement (>/= 2 cm), suprarenal paraaortic lymph nodes (>/= 1 cm), omental extension (spleen, stomach, or lesser sac), and pelvic sidewall involvement and/or hydroureter were most strongly associated with surgical outcome. Using the Predictive Index scores, a receiver operating characteristic curve was generated with an area under the curve = 0. 969 +/- 0.023. In the final model, a Predictive Index score >/= 4 had the highest overall accuracy at 92.7% and identified patients undergoing suboptimal surgery with a sensitivity of 100% (21/21). The specificity, or ability to identify patients undergoing optimal surgery, was 85.0% (17/20). The PPV of a Predictive Index score >/= 4 was 87.5% (21/24), and the NPV was 100%. The ability of this model to correctly predict surgical outcome was statistically significant (P < 0.001). CONCLUSIONS: In this model, a Predictive Index score >/= 4 demonstrated high sensitivity, specificity, PPV, and NPV, and was highly accurate in identifying patients with advanced epithelial ovarian carcinoma unlikely to undergo optimal primary cytoreductive surgery. The Predictive Index model may have clinical utility in guiding the management of patients with ovarian carcinoma.

Anatomy of pelvic arteries adjacent to the sacrospinous ligament: importance of the coccygeal branch of the inferior gluteal artery.

OBJECTIVE: To describe the arterial vascular anatomy in the area of the sacrospinous ligament. METHODS: Cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament with emphasis on vascular and neuroanatomy. Flexible rulers were used to measure the coccygeal branch in five hemipelvises. RESULTS: The pudendal vessels and nerve pass immediately medial and inferior to the ischial spine (within 0.5 cm of the spine) and behind the sacrospinous ligament. The pudendal artery lies anterior to the sacrotuberous ligament, which passes behind the ischial spine to its attachment at the posterior ischial tuberosity. The inferior gluteal artery originates from the posterior or the anterior branch of the internal iliac artery to pass behind the sciatic nerve and the sacrospinous ligament. There is a 3- to 5-mm window in which the inferior gluteal vessel is left uncovered above the top of the sacrospinous ligament and below the lower edge of the main body of the sciatic nerve plexus. The coccygeal branch of the inferior gluteal artery passes immediately behind the midportion of the sacrospinous ligament and pierces the sacrotuberous ligament in multiple sites. The main body of the inferior gluteal artery leaves the pelvis by passing posterior to the upper edge of the sacrospinous ligament and following the inferior portion of the sciatic nerve out of the greater sciatic foramen. CONCLUSION: Sutures placed through the sacrospinous ligament at least 2.5 cm from the ischial spine along the superior border of the sacrospinous ligament and without transgressing the entire thickness are in an area generally free of arterial vessels.

Dose-intensive approaches to ovarian cancer.

Increasing the total dose or the dose intensity of platinum does not improve survival in women with ovarian cancer. High-dose chemotherapy with hematologic support has not been shown to be more effective than standard-dose chemotherapy. Regional dose intensity, through intraperitoneal chemotherapy, may have a role in the treatment of advanced ovarian cancer. Further studies are needed to identify the optimal combination of agents, in addition to a platinum and a taxane, to be used in primary therapy for ovarian cancer.

Accuracy and intraobserver variability of simulated cervical dilatation and effacement measurements.

Objective: To assess the accuracy and intraobserver variability of clinical cervical diameter measurements among obstetric health care providers.Methods: Cervical dilatation and effacement simulators consisting of pelvic blocks composed of synthetic rubber were used for the study. The examiners had to rely solely on proprioception to determine dilatation and effacement.Results: A total of 828 simulated cervical diameter and effacement measurements were obtained from 69 different examiners. The overall accuracy for determining the exact diameter was 48.6%, which improved to 88.8% when an error of +/- 1 cm was allowed. Intraobserver variability for a given diameter measurement was 39.9%, which decreased to 14.0% when an error of +/- 1 cm was allowed. The overall accuracy for determining the exact effacement was 52.9%, which improved to 85.8% when an error of +/- 25% was allowed. Intraobserver variability for a given effacement measurement was 37.0%, which decreased to 7.3% when an error of +/- 25% was allowed.Conclusions: Cervical diameter and effacement measurements obtained by digital exam are precise when an error of +/- 1 cm in diameter and +/- 25% effacement is allowed. Intraobserver variability is > 35% and is an important consideration when evaluating dysfunctional labor.

[The ophthalmologist B. Adamandiadis and the history of the "Adamandiadis-Behçet syndrome"]. / Der Augenarzt B. Adamandiadis und die Geschichte des "Adamandiadis-Behçet-Syndroms".

This article presents the scientific and social work of Benedikt Adamandiadis and the history of the "Adamandiadis-Behçet syndrome". The authors also attempt to describe the inestimable contribution to modern Greek ophthalmology. It is not the authors' intention to underscore Adamandiadis' importance as the discoverer of the syndrome - for him, the fulfillment of his duties as a scientist and a human being was always more important than personal fame -, but merely to correct an historical injustice.

[Is the postoperative course following goniotrepanation modified by the age of the patient?]. / Wird der postoperative Verlauf nach Goniotrepanation vom Alter des Patienten beeinflusst?

The authors tried to establish whether the patient's age has any bearing on the postoperative course of goniotrepanation. A total of 150 eyes operated on, which had been regularly followed up for more than 10 years, were classified in three age groups, each comprising 50 eyes. The following parameters were evaluated: indication for the operation, behavior of the postoperative I.O.P., behaviour of the filtering bleb, behavior of the visual functions, and late complications. The comparative investigations produced the following findings: (1) The postoperative mean IOP value is independent of the patient's age; (2) visual functions were adversely affected to a significant degree postoperatively in older patients, and (3) a cystic configuration of the filtering bleb was significantly more common in older individuals. On the basis of these findings the authors recommend covered sclerectomy procedures, even in younger individuals suffering from chronic simple glaucoma, because the prognosis for the functions and the ultimate fate of the eye is reasonably good.

[The role of the parathalamus in covered sclerectomy]. / Die Rolle des Parathalamus bei der "gedeckten Sklerektomie".

Twenty-six eyes in which IOP had been regulated at a mean 14 mmHg by goniotrepanation were operated on for cataract after an interval of at least 4 years. On exposing the scleral flap the authors discovered gray-black funiculi on the two unsutured vertical sides, representing new fluid-permeable membranous tissue. Beneath them was a fairly small fluid-filled space, the " parathalmus " - a kind of secondary anterior chamber.

[The significance of the scleral flap for the surgery of glaucoma (author's transl)]. / Die Bedeutung des Skleralappens für die Chirurgie des Glaukoms.

The importance of the scleral flap used in the covered fistulising operations is reported. The authors describe in detail significant observations contributing to the successful outcome of these operations. They make the hypothesis, supported by their microsurgical observations, for the formation of a slit-like space under the scleral flap, named "Parathalamus", which is an extension of the anterior chamber. This space communicates with the anterior chamber through the trephination hole. The aquous humor flows to the subconjunctival space through a fine membraneous tissue, formed on the surface of the lips of the "parathalamus".

[Local prophylactic measures to prevent postoperative infection after cataract operations (author's transl)]. / Lokale Prophylaxe gegen postoperative Infektionen nach Kataraktoperationen.

The Allen procedure to prevent postoperative endophthalmitis has been applied in cataract operations since 1973. Postoperative endophthalmitis has been observed through the years 1965--1973 in 0.49% of registered cases, while the infection rate has now been lowered to 0.067%.

[A modified goniotrephination technique (procedure to secure more permanent drainage) (author's transl)]. / Modifizierte Technik der Goniotrepanation (Technik zur Erreichung eines beständigen Abflussweges)

Two modified operative techniques using non-absorbable synthetic material based on the goniotrephination are described. The material used is embedded under the scleral flap at the trephination site. The procedure aims at creating a more stable and eventually a more permanent drainage. Both techniques are dealt with in detail, and the clinical results regarding the first twelve cases are reported covering an observation period of one to six months.