Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 39
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Spine J ; 20(6): 915-924, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32087389

RESUMO

BACKGROUND CONTEXT: Metastatic spine disease (MSD) is becoming more prevalent as medical treatment for cancers advance and extend survival. More MSD patients are treated surgically to maintain neurological function, ambulation, and quality of life. PURPOSE: The purpose of this study was to use a large, nationally representative database to examine the trends, patient outcomes, and health-care resource utilization associated with surgical treatment of MSD. DESIGN: This was an epidemiologic study using national administrative data from the Nationwide Readmissions Database (NRD). PATIENT SAMPLE: All patients in the NRD from 2010 to 2014 who underwent spinal surgery were included in the study. OUTCOME MEASURES: Mortality, blood transfusion, complications, length of stay, cost, and discharge location during index hospitalization as well as hospital readmission and revision surgery within 90-days of surgery were analyzed. METHODS: International Classification of Diseases, Ninth Revision, (ICD-9) codes was used to identify patients of interest within the NRD from 2010 to 2014. Patients were separated into two cohorts - those with MSD and those without. Trends for surgical treatment of MSD were assessed and outcomes measures for both cohorts were analyzed and compared. RESULTS: The number of surgical treatments for MSD increased from 6,007 in 2010 to 7,032 in 2014 (p-trend<.0001) which represented a 17.1% increase. During index hospitalization, MSD patients had an increased risk of mortality (odds ratio [OR]=3.22, 95% confidence interval [CI]: 2.85-3.63, p<.0001), blood transfusion (OR=2.93, 95% CI: 2.66-3.23, p<.0001), any complication (OR=1.24, 95% CI: 1.18-1.31, p<.0001), and discharge to skilled nursing facility (OR=1.51, 95% CI:1.41-1.61, p<.0001). MSD patients had longer average length of stay (13.05 vs. 4.56 days, p<.0001) and cost ($49,421.75 vs. $26,190.37, p<.0001) during index hospitalization. Furthermore, MSD patients had an increased risk of hospital readmission (OR=2.82, 95% CI: 2.68-2.96, p<.0001), readmission for surgical site infection (OR=2.38, 95% CI: 2.20-2.58, p<.0001), and readmission with neurologic deficits (OR=1.62, 95% CI: 1.27-2.06, p<.0001) despite a decreased risk of revision fusion (OR=0.71, 95% CI: 0.53-0.96, p=.026). CONCLUSIONS: The number of MSD patients who undergo surgical treatments is increasing. Not only do these patients have worse outcomes during index hospitalization, but they are also at an increased risk of hospital readmission for surgical site infection and neurologic complications. These findings stress the need for multidisciplinary perioperative treatment plans that mitigate risks and facilitate quick, effective recovery in these unique, at-risk patients.

2.
Spine (Phila Pa 1976) ; 43(22): 1559-1565, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29642137

RESUMO

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: The aim of this study was to determine the nationwide trends and complication rates associated with outpatient posterior lumbar fusion (PLF). SUMMARY OF BACKGROUND DATA: Outpatient lumbar spine fusion is now possible secondary to minimally invasive techniques that allow for reduced hospital stays and analgesic requirements. Limited data are currently available regarding the clinical outcome of outpatient lumbar fusion. METHODS: The Humana administrative claims database was queried for patients who underwent one to two-level PLF (CPT-22612 or CPT-22633 AND ICD-9-816.2) as either outpatients or inpatients from Q1 2007 to Q2 2015. The incidence of perioperative medical and surgical complications was determined by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate odds ratios (ORs) of complications among outpatients relative to inpatients undergoing PLF. RESULTS: Cohorts of 770 patients who underwent outpatient PLF and 26,826 patients who underwent inpatient PLF were identified. The median age was in the 65 to 69 years age group for both cohorts. The annual relative incidence of outpatient PLF remained stable across the study period (R = 0.03, P = 0.646). Adjusting for age, gender, and comorbidities, patients undergoing outpatient PLF had higher likelihood of revision/extension of posterior fusion [(OR 2.33, confidence interval (CI) 2.06-2.63, P < 0.001], anterior fusion (OR 1.64, CI 1.31-2.04, P < 0.001), and decompressive laminectomy (OR 2.01, CI 1.74-2.33, P < 0.001) within 1 year. Risk-adjusted rates of all other postoperative surgical and medical complications were statistically comparable. CONCLUSION: Outpatient lumbar fusion is uncommonly performed in the United States. Data collected from a national private insurance database demonstrate a greater risk of postoperative surgical complications including revision anterior and posterior fusion and decompressive laminectomy. Surgeons should be cautious in performing PLF in the outpatient setting, as the risk of revision surgery may increase in these cases. LEVEL OF EVIDENCE: 3.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/tendências , Vigilância da População , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos
3.
Spine J ; 18(7): 1180-1187, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29155340

RESUMO

BACKGROUND CONTEXT: With the changing landscape of health care, outpatient spine surgery is being more commonly performed to reduce cost and to improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population. PURPOSE: The objective of this study was to determine the nationwide trends and relative complication rates associated with outpatient ACDF. STUDY DESIGN/SETTING: This is a large-scale retrospective case control study. PATIENT SAMPLE: The patient sample included Humana-insured patients who underwent one- to two-level ACDF as either outpatients or inpatients from 2011 to 2016 OUTCOME MEASURES: The outcome measures included incidence and the adjusted odds ratio (OR) of postoperative medical and surgical complications within 1 year of the index surgery. MATERIALS AND METHODS: A retrospective review was performed of the PearlDiver Humana insurance records database to identify patients undergoing one- to two-level ACDF (Current Procedural Terminology [CPT]-22551 and International Classification of Diseases [ICD]-9-816.2) as either outpatients or inpatients from 2011 to 2016. The incidence of perioperative medical and surgical complications was determined by querying for relevant ICD and CPT codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate ORs of complications among outpatients relative to inpatients undergoing ACDF. RESULTS: Cohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the 65-69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=.04). Adjusting for age, gender, and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, confidence interval [CI] 1.27-1.96, p<.001) and 1 year (OR 1.79, CI 1.51-2.13, p<.001) postoperatively. Outpatient ACDF was also associated with a higher likelihood of revision anterior fusion at 1 year postoperatively (OR 1.46, CI 1.26-1.70, p<.001). Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient ACDF (OR 1.25, CI 1.06-1.49, p=.010). Adjusted rates of all other queried surgical and medical complications were comparable. CONCLUSIONS: Outpatient ACDF is increasing in frequency nationwide over the past several years. Nationwide data demonstrate a greater risk of perioperative surgical complications, including revision anterior and posterior fusion, as well as a higher risk of postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Estudos de Casos e Controles , Bases de Dados Factuais , Discotomia/métodos , Feminino , Humanos , Incidência , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/métodos
4.
Cureus ; 10(11): e3576, 2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30656080

RESUMO

Behcet's disease is inflammatory vasculitis that has a high incidence of mortality in patients with pulmonary artery aneurysm (PAA) formation. Traditionally, patients with Behcet's disease and PAA rupture undergo invasive surgical management. Surgical intervention; however, has been shown to have high complication, failure, and mortality rates. It has become a more contemporary practice to utilize the interventional embolization of pulmonary artery aneurysms (PAAs) in patients with Behcet's disease and other various etiologies because of its inherent minimally invasive nature and decreased risk for complications. The management paradigm for treating PAAs has shifted toward endovascular embolization even in severe or emergent cases where surgical management was once thought to be the standard. The following case is a testimony to the practicality of interventional embolization in the setting of a symptomatic patient presenting with PAAs.

5.
Spine (Phila Pa 1976) ; 42(9): 644-652, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28441682

RESUMO

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To determine the epidemiology and prognostic indicators in patients with chondrosarcoma of the osseous spine. SUMMARY OF BACKGROUND DATA: Chondrosarcoma of the spine is rare, with limited data on its epidemiology, clinicopathologic features, and treatment outcomes. Therapy centers on complete en bloc resection with radiotherapy reserved for subtotal resection or advanced disease. METHODS: The Surveillance, Epidemiology, and End Results Registry was queried for patients with chondrosarcoma of the osseous spine from 1973 to 2012. Study variables included age, sex, race, year of diagnosis, size, grade, extent of disease, and treatment modality. RESULTS: The search identified 973 cases of spinal chondrosarcoma. Mean age at diagnosis was 51.6 years, and 627% of patients were males. Surgical resection and radiotherapy were performed in 75.2% and 21.3% of cases, respectively. Kaplan-Meier analysis demonstrated overall survival (OS) and disease-specific survival (DSS) of 53% and 64%, respectively, at 5 years. Multivariate Cox regression analysis showed that age (OS, P < 0.001; DSS, P = 0.007), grade (OS, P < 0.001; DSS, P < 0.001), surgical resection (OS, P < 0.001; DSS, P < 0.001), and extent of disease (OS, P < 0.001; DSS, P < 0.001) were independent survival determinants; tumor size was an independent predictor of OS (P = 0.006). For confined disease, age (P = 0.013), decade of diagnosis (P = 0.023), and surgery (P = 0.017) were independent determinants of OS. For locally invasive disease, grade (OS, P < 0.001; DSS, P = 0.003), surgery (OS, P = 0.013; DSS, P = 0.046), and size (OS, P = 0.001, DSS, P = 0.002) were independent determinants of OS and DSS. Radiotherapy was an independent indicator of worse OS for both confined (P = 0.004) and locally invasive disease (P = 0.002). For metastatic disease, grade (OS, P = 0.021; DSS, P = 0.012) and surgery (OS, P = 0.007; DSS, P = 0.004) were survival determinants for both OS and DSS, whereas radiotherapy predicted improved OS (P = 0.039). CONCLUSION: Surgical resection confers survival benefit in patients with chondrosarcoma of the spine independent of extent of disease. Radiotherapy improves survival in patients with metastatic disease and worsens outcomes in patients with confined and locally invasive disease. LEVEL OF EVIDENCE: 4.


Assuntos
Condrossarcoma , Neoplasias da Coluna Vertebral , Adulto , Idoso , Condrossarcoma/diagnóstico , Condrossarcoma/epidemiologia , Condrossarcoma/mortalidade , Condrossarcoma/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Programa de SEER , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/terapia
6.
Spine J ; 17(5): 645-655, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27856382

RESUMO

BACKGROUND CONTEXT: Osteosarcoma (OGS) and Ewing sarcoma (EWS) are the two classic primary malignant bone tumors. Due to the rarity of these tumors, evidence on demographics, survival determinants, and treatment outcomes for primary disease of the spine are limited and derived from small case series. PURPOSE: To use population-level data to determine the epidemiology and prognostic indicators in patients with OGS and EWS of the osseous spine. STUDY DESIGN/SETTING: Large-scale retrospective study. PATIENT SAMPLE: Patients diagnosed with OGS and EWS of the spine in the Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2012. OUTCOME MEASURES: Overall survival (OS) and disease-specific survival (DSS). METHODS: Two separate queries of the SEER registry were performed to identify patients with OGS and EWS of the osseous spine from 1973-2012. Study variables included age, sex, race, year of diagnosis, tumor size, extent of disease (EOD), and treatment with surgery and/or radiation therapy. Primary outcome was defined as OS and DSS in months. Univariate survival analysis was performed using the Kaplan-Meier method and the log-rank test. Multivariate analysis was performed using Cox proportional hazards regression models. RESULTS: The search identified 648 patients with primary OGS and 736 patients with primary EWS of the spine from 1973 to 2012. Mean age at diagnosis was 48.1 and 19.9 years for OGS and EWS, respectively, with OGS showing a bimodal distribution. The median OS and DSS were 1.3 and 1.7 years, respectively, for OGS, with OGS in Paget's disease having worse OS (0.7 years) relative to the mean (log-rank p=.006). The median OS and DSS for EWS were 3.9 and 4.3 years, respectively. Multivariate cox regression analysis showed that age (OS p<.001, DSS p<.001), decade of diagnosis (OS p=.049), surgical resection (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent positive prognostic indicators for spinal OGS; radiation therapy predicted worse OS (hazard ratio [HR] 1.48, confidence interval [CI] 1.05-2.10, p=.027) and DSS (HR 1.74, CI 1.13-2.66, p=.012) for OGS. For EWS, age (OS p<.001, DSS p<.001), surgical resection (OS p=.030, DSS p=.046), tumor size (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent determinants of improved survival; radiation therapy trended toward improved survival but did not achieve statistical significance for both OS (HR 0.76, CI 0.54-1.07, p=.113) and DSS (0.76, CI 0.54, 1.08, p=.126). CONCLUSIONS: Age, surgical resection, and EOD are key survival determinants for both OGS and EWS of the spine. Radiation therapy may be associated with worse outcomes in patients with OGS, and is of potential benefit in EWS. Overall prognosis has improved in patients with OGS of the spine over the last four decades.


Assuntos
Sarcoma de Ewing/patologia , Neoplasias da Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Programa de SEER , Sarcoma de Ewing/epidemiologia , Sarcoma de Ewing/terapia , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Análise de Sobrevida , Adulto Jovem
7.
Curr Top Med Chem ; 16(28): 3133-3174, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27291985

RESUMO

This review discusses the biological and medicinal significance of one of the most important and interesting heterocyclic ring systems, the pyrimidine and its condensed derivatives. Herein, various physiologically important molecules, as well as, therapeutically used drugs having a pyrimidine or condensed pyrimidine system in their chemical structures, have been covered. The chemistry and synthesis of pyrimidines have also been briefly discussed.


Assuntos
Pirimidinas/química , Humanos
8.
J Neurosurg Spine ; 25(2): 234-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27015132

RESUMO

Parkes Weber syndrome (PWS) is a congenital overgrowth disorder characterized by unilateral limb and axial hypertrophy, capillary malformations of the skin, and high-flow arteriovenous fistulas (AVFs). Spinal AVFs in the setting of PWS are challenging vascular lesions that often contain multiple arteriovenous (AV) shunts. The present case report highlights an adolescent girl with PWS who presented with a ruptured complex high-flow conus medullaris AVF. She was successfully treated with endovascular embolization and microsurgery. At the 2-year follow-up, the patient remained free of neurological symptoms and had no recurrence of the vascular malformation.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Síndrome de Sturge-Weber/complicações , Síndrome de Sturge-Weber/terapia , Adolescente , Fístula Arteriovenosa/diagnóstico por imagem , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Síndrome de Sturge-Weber/diagnóstico por imagem , Resultado do Tratamento
9.
Rev Environ Health ; 31(2): 251-7, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-26812757

RESUMO

INTRODUCTION: Musculoskeletal injury exerts a significant burden on US industry. The purpose of this study was to investigate the frequency and characteristics of musculoskeletal injuries in the California (CA) film and motion picture (FMP) industry which may result in unforeseen morbidity and mortality. METHODS: We reviewed the workers' compensation (WC) claims database of the Workers' Compensation Insurance Rating Bureau of California (WCIRB) and employment statistics through the US Bureau of Labor Statistics (BLS). We analyzed the frequency, type, body part affected, and cause of musculoskeletal injuries. RESULTS: From 2003 to 2009, there were 3505 WC claims of which 94.4% were musculoskeletal. In the CA FMP industry, the most common injuries were strains (38.4%), sprains (12.2%), and fractures (11.7%). The most common sites of isolated injury were the knee (18.9%), lower back (15.0%), and ankle (8.6%). Isolated musculoskeletal spine injuries represented 19.3% of all injuries. The most common causes of injury were work-directed activity (36.0%) and falls (25.5%). CONCLUSION: We present the first report on the unique profile of musculoskeletal injury claims in the FMP industry. This data provides direction for improvement of workplace safety.


Assuntos
Indústrias , Filmes Cinematográficos , Sistema Musculoesquelético/lesões , Traumatismos Ocupacionais/epidemiologia , California/epidemiologia , Bases de Dados Factuais , Humanos , Traumatismos Ocupacionais/diagnóstico , Risco , Indenização aos Trabalhadores
10.
Int J Spine Surg ; 9: 59, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26609514

RESUMO

BACKGROUND: Yolk sac tumors (YST) are malignant neoplasms. They are a subtype of germ cell tumors and typically originate in the gonads although extragonadal origins of such tumors have been described. Yolk sac tumors are commonly found in the gonads of infants and children and are extremely rare in adults. The goal of this case report is to describe the clinical presentation of a rare case of metastatic extragonadal yolk sac tumor originating from the mediastinum and causing an acute conus medullaris syndrome in an adult male. METHODS: A 47-year old male presented to our emergency department with a one-day history of bilateral lower extremity weakness, urinary retention and bowel incontinence. Imaging revealed a destructive lesion and a burst fracture of the first lumbar vertebral body (L1) with severe spinal canal stenosis. An urgent spinal decompression and fusion was performed. Oncologic workup revealed a yolk sac tumor originating from the mediastinum. RESULTS: His neurologic function, including motor strength, bowel and bladder function improved in the postoperative period. Chemotherapy regimen of ifosfamide, etoposide and cisplatin was administered and radiation therapy was administered to the spine tumor bed. CONCLUSIONS: Yolk sac tumors, although rare, should be considered in the long list differential diagnosis of an otherwise healthy male presenting with conus medullaris or spinal cord compression from metastatic disease without evidence of a testicular mass. Prompt diagnosis with urgent decompression of neural structures and stabilization of the spine may result in improvement in neurological function.

11.
Glob Public Health ; 4(1): 31-49, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19153929

RESUMO

Ecosystem approaches recognize the complexity of many contemporary public health challenges and offer an alternative for dealing with problems that have proven intractable and unresponsive to conventional public health strategies. Infectious disease outbreaks are among the most dramatic aspects of systems failure, and the Canadian cases of SARS (Severe Acute Respiratory Syndrome) in Toronto, and the E. coli outbreak in Walkerton, serve as useful illustrative examples. This paper examines some of the limitations of current public health approaches, the fundamental tenets of an alternative, transdisciplinary ecosystem approach, and changes necessary for implementation, including those in philosophical approach, communications and education, and, finally, institutions and governance.


Assuntos
Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Administração em Saúde Pública/métodos , Síndrome Respiratória Aguda Grave/epidemiologia , Vacinas Bacterianas , Canadá/epidemiologia , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Comunicação Interdisciplinar , Vigilância da População , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Vacinas Virais
12.
Ann Vasc Surg ; 23(1): 116-21, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-18640818

RESUMO

The aim of this ex vivo experimental study was to assess the effect of smoking, diabetes mellitus, and hypertension on endothelial function in human saphenous vein, a commonly used conduit for coronary and peripheral arterial bypass surgery. A segment of long saphenous vein harvested during infrainguinal bypass surgery was mounted in an organ bath for isometric tension studies. Vein rings were precontracted to submaximal contraction with phenylephrine, followed by endothelium-dependent relaxation with acetylcholine. Long saphenous vein segments were collected from 26 patients, including five females, with a mean age of 66.4 years (range 48-92). Current smokers had impaired endothelium-dependent relaxation compared to ex- and nonsmokers (10.2%, n=13, vs. 32.9%, n=13; p<0.010). However, ex-smokers and nonsmokers did not have a significant difference in relaxant responses to acetylcholine (29.1%, n=8, vs. 24.6%, n=5; p=nonsignificant [ns]). Similarly, diabetic and nondiabetic patients did not show a significant difference in endothelium-dependent relaxation (23.1%, n=10, vs. 15.6%, n=16; p=ns). The relaxant responses in hypertensive and normotensive patients were not different (20.4%, n=12, vs. 22.5%, n=14; p=ns). Smoking has a deleterious effect on the endothelial function of saphenous vein, and smoking cessation may improve the long-term durability of saphenous vein used as a bypass graft in patients undergoing arterial reconstruction.


Assuntos
Diabetes Mellitus/fisiopatologia , Endotélio Vascular/fisiopatologia , Hipertensão/fisiopatologia , Veia Safena/fisiopatologia , Fumar/fisiopatologia , Vasodilatação , Acetilcolina/farmacologia , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena/transplante , Fumar/efeitos adversos , Vasodilatação/efeitos dos fármacos , Vasodilatadores/farmacologia
13.
Asian J Surg ; 31(4): 211-5, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19010766

RESUMO

OBJECTIVE: Until recently, surgeons have been posed with a dilemma---whether or not they should preserve the terminal end of the distal rectal pouch and the fistula region in anorectal malformations (ARMs). A detailed histological study of this region was conducted to establish a consensus for preserving or excising this region for reconstruction of ARMs. METHODS: Histopathological examination using haematoxylin and eosin-stained sections of the terminal portion of the distal rectal pouch and proximal portion of the rectourogenital or rectoperineal connection was performed in 60 cases of high, intermediate and low ARMs. RESULTS: Distorted internal sphincter was present in 93.3% of high, 90% of intermediate and 100% of low ARMs. The proximal fistula region was lined by transitional epithelium in 50% of cases, and anal glands were present in 83.3% and anal crypts in 68.3% of cases. The rectal pouch in the region of the internal sphincter and fistula was aganglionic in all cases. CONCLUSION: This study shows that the terminal end of the distal rectal pouch and proximal fistula region possess distorted anal features with aganglionosis, and contradicts the recommendation that this region should be reconstructed in patients with malformations.


Assuntos
Canal Anal/anormalidades , Fístula Retal/patologia , Fístula Retovaginal/patologia , Reto/anormalidades , Reto/patologia , Feminino , Humanos , Masculino
14.
Asian J Surg ; 31(4): 225-9, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19010769

RESUMO

OBJECTIVE: Advanced and inoperable solid tumours in children have high mortality despite aggressive multimodal treatment. Intravenous chemotherapy is abandoned at times because of systemic toxicity. This study investigated intratumoural chemotherapy and compared it with intravenous chemotherapy. METHODS: Forty children with advanced inoperable solid tumours (Wilms' tumour and neuroblastoma) were randomly allocated into two groups of 20. Group A was given intratumoural chemotherapy and group B was given intravenous chemotherapy. Both groups were compared for reduction in tumour size and volume, tumour resectability, histopathological changes and drug side effects. RESULTS: Intratumoural chemotherapy was superior to intravenous chemotherapy in terms of reducing tumour size and volume (63% in group A vs. 22% in group B). The resectability was 70% in the intratumoural group compared with 40% in the intravenous group. The overall good histopathological response was 71% in group A as opposed to 0% in group B. Moreover, the incidence and severity of drug side effects and morbidity were less with intratumoural chemotherapy. Mortality was also low in group A (5%) compared to group B (20%). CONCLUSION: Intratumoural chemotherapy can be offered as an effective and safe alternative treatment modality for advanced and inoperable Wilms' tumour and neuroblastoma.


Assuntos
Antineoplásicos/administração & dosagem , Neuroblastoma/tratamento farmacológico , Tumor de Wilms/tratamento farmacológico , Criança , Humanos , Injeções Intralesionais , Injeções Intravenosas , Neuroblastoma/patologia , Tumor de Wilms/patologia
15.
Can J Gastroenterol ; 22(3): 243-6, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18354752

RESUMO

BACKGROUND: Esophagogastroduodenoscopy (EGD) is the most frequently performed diagnostic procedure for upper gastrointestinal disorders. The procedure is routinely performed under conscious sedation in North America. A significant proportion of morbidity and mortality associated with EGD is related to hypoxia due to conscious sedation. The use of sedation is also associated with an increase in cost, loss of work on the day of endoscopy and the need for the patient to be accompanied home after the procedure. Transnasal endoscopy has advantages such as no sedation and less patient monitoring, nursing time and expenses than conventional per oral EGD. OBJECTIVES: To assess the feasibility and acceptability of unsedated transnasal EGD in daily practice. METHODS: Patients due to undergo EGD were given a choice of either unsedated transnasal EGD or per oral EGD with sedation. Patients who chose unsedated transnasal EGD had the procedure performed in the office by a senior gastroenterologist with experience in transnasal EGD. All procedures were performed using a small-calibre esophagogastroduodenoscope. All patients were surveyed using a patient satisfaction questionnaire, and were asked to give specific scores in terms of choking sensation, sore throat, nasal discomfort and abdominal discomfort. All variables were assessed by scores between 0 and 10, with 10 indicating the most severe degree of each variable. Any complications were also recorded. RESULTS: Between March 2002 and August 2003, 231 patients underwent transnasal EGD. The median age of the patients was 57 years (range 15 to 87 years). Complete examinations were possible in 98% of patients. Patients reported a high degree of acceptability (mean score 6.6, range 1 to 10) and low degrees of choking sensation (mean 1.8, range 0 to 10), nasal discomfort (mean 1.7, range 0 to 10), sore throat (mean 0.8, range 0 to 9) and abdominal discomfort (mean 1.1, range 0 to 10). The only complications reported by the patients were epistaxis (n=2, 0.9%) and sinusitis (n=1, 0.4%). Some patients also reported transient light-headedness (n=12, 5%) and mucous discharge (n=2, 0.9%). When asked, 185 patients (88%) stated that they were willing to undergo the same procedure in the future if medically indicated. Of the 84 patients who had conventional EGD under conscious sedation in the past, 52 patients (62%) preferred transnasal EGD without sedation. CONCLUSIONS: Transnasal EGD is generally well tolerated, feasible and safe. It can be performed with topical anesthesia in an outpatient setting. The low complication rate, high patient satisfaction and potential cost savings make transnasal endoscopy an attractive alternative to conventional EGD to screen patients for upper gastrointestinal tract diseases.


Assuntos
Endoscopia do Sistema Digestório/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sedação Consciente , Dispepsia/diagnóstico , Feminino , Azia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente
16.
Ann Vasc Surg ; 21(1): 34-8, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17349333

RESUMO

This study assessed the validity of the Hardman index in predicting outcome following open repair of ruptured abdominal aortic aneurysm and whether this scoring system can be used reliably to select patients for surgical repair. Patients undergoing open repair of ruptured abdominal aortic aneurysm in two university teaching hospitals over a 5-year period were identified from a computerized hospital database. Thirty-day mortality was the main outcome measure. Five Hardman index factors were calculated and related to outcome retrospectively. There were 178 patients with a mean age of 73.9 years (range 51-94) and a male to female ratio of 5.4:1. The overall in-hospital mortality was 57.3% (102/178). Univariate analysis of risk factors showed that age >76 years (P = 0.007, odds ratio [OR] 2.34, 95% confidence interval [CI] 1.26-4.37) and electrocardiograghic evidence of ischemia on admission (P = 0.002, OR 3.75, 95% CI 1.57-8.93) were associated with high mortality. However, loss of consciousness (P = 0.155, OR 1.56, 95% CI 0.85-2.86), hemoglobin <9 g/dL (P = 0.118, OR 1.89, 95% CI 0.85-4.22), and serum creatinine >0.19 mmol/L (P = 0.691, OR 1.25, 95% CI 0.42-3.70) were not significant predictors of mortality. Using a multivariate analysis, age >76 years (P = 0.043, OR 2.29, 95% CI 1.03-5.11) and myocardial ischemia (P = 0.029, OR 2.93, 95% CI 1.12-7.67) were again found to be the significant predictors of mortality. The operative mortality was 44%, 46%, 68%, 79%, and 100% for Hardman scores of 0, 1, 2, 3, and 4, respectively. No patient had a score of 5. The Hardman index is not a reliable predictor of outcome following repair of ruptured abdominal aortic aneurysm. High-risk patients may still survive and should not be denied surgical repair based on the scoring system alone. Further evaluation of the risk factors is required to reliably and justifiably exclude those patients in whom the intervention is inappropriate.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Resultado do Tratamento
18.
Postgrad Med J ; 81(954): 232-5, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15811886

RESUMO

Autonomic dysreflexia is an important clinical diagnosis that requires prompt treatment to avoid devastating complications. The condition may present itself to all members of medical and surgical specialties, who may not be accustomed to treating it. It is the clinician's responsibility to have a basic understanding of the pathophysiology of the condition and the simple steps required to treat it.


Assuntos
Disreflexia Autonômica/terapia , Doença Aguda , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/etiologia , Emergências , Tratamento de Emergência , Humanos
20.
Cardiovasc Intervent Radiol ; 27(5): 523-4, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15461978

RESUMO

Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Transplante de Rim , Procedimentos Cirúrgicos Vasculares , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Imageamento Tridimensional , Tomografia Computadorizada Espiral
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA