Patient Selection (Total 212069 Papers Found)

IMPORTANCE Endovascular technology has become ubiquitous in the modern care of abdominal aortic aneurysm (AAA), yet broad estimates of its efficacy among variable hospital and regional settings is not known. OBJECTIVE To perform a preliminary analysis of hospital effects on mortality following open AAA repair (OAR) and endovascular AAA repair (EVAR). DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program da ...
With the continuous increase in the numbers and complexity of cases being done as ambulatory procedures, striking a balance between operational efficiency, patient safety, and patient satisfaction has become increasingly difficult. This article summarizes the latest evidence and consensus with regard to discharging an ambulatory patient home, the use of patient recovery scoring systems for protocol-based decision making, the concept of fast-track recovery, and requirements for patient escort. Fa ...
Tube stents are widely used to achieve internal urinary drainage in the urology field. Recently, in an attempt to improve upon metallic stents, these stents were introduced for use in the obstructed urethra and ureter. We review the current indications and devices for internal urinary drainage using metallic stents. In recent years, intraprostatic metallic stents have been established as a minimally invasive alternative treatment for benign prostatic hyperplasia (BPH). Appropriate patient select ...
Die chirurgische Therapie der Beckenbodeninsuffizienz fokussiert sich im Wesentlichen auf zwei funktionelle Störungen, die Darmobstruktion und die Stuhlinkontinenz. Der Stellenwert der chirurgischen Therapie ist hier insbesondere nach Nichtansprechen der konservativen Möglichkeiten zu sehen. Die Differenzialindikation der operativen Verfahren basiert auf einer präzisen präoperativen Evaluation. Das Ausmaß der funktionellen Beeinträchtigung wird anhand einer ausführlichen Anamnese unter Ve ...
Laparoscopic repair of ventral and incisional hernia has become increasingly popular as compared to open repair. The procedure has the advantages of minimal access surgery, reduction of post operative pain and the recurrence rate. A prospective study of laparoscopic incisional hernia repair was performed in our center from August 2002 to April 2004. Eighteen cases (n: 18) were performed during the study period. Fifteen cases (n: 15) had open hernia repair previously. Sixteen patients (n: 16) had ...
Surgical treatment of distal rectal cancer has long been based only on abdominoperineal excision, resulting in a permanent stoma and not always offering a definitive local control. Sphincter saving surgery has emerged in the last 20 years and can be offered also to patients with low lying tumours, provided that the external sphincter is not involved by the disease. An intersphincteric resection (ISR) is based on the resection of the rectum with a distal dissection proceeding into the space betw ...
Technical aspects are crucial for planning and performing successful endovascular repair of abdominal aortic aneurysms (AAA). Planning should be based on high-quality computed tomography angiography scans with a slice thickness of ≤ 1 mm. However, even without a workstation for image postprocessing, important angle estimations can be easily performed. Several devices are available today to treat abdominal aneurysms. In most elective cases all currently available 3rd generation devices perform ...
Home intravenous (IV) antimicrobial therapy is a well accepted and widely practiced form of home infusion therapy. Orthopaedic-related infections, often requiring long courses of therapy, are commonly treated in the home setting after a brief hospitalization. Hospital orthopaedic nurses play an important role in preparing patients for home care. This article addresses patient selection for home IV therapy, the discharge planning process, and educational preparation of the patient. The role of th ...
Sorafenib (SO) was the first systemic agent to demonstrate a significant improvement in overall survival in patients with advanced hepatocellular carcinoma (HCC); international guidelines now recommend SO as a first-line treatment in patients with unresectable HCC who are not eligible for locoregional therapies and maintain preserved liver function. However, therapy with SO may require close management to further optimize the clinical outcomes and limit the onset of adverse events (AEs). SO has ...
BACKGROUND Failed back surgery syndrome (FBSS) is a condition in which there is failure to improve satisfactorily after back surgery. It is characterized by intractable pain and various degrees of functional disability after lumbar spine surgery. It is estimated that this complication occurs in 5% to 10% of patients after spinal surgeries. The major causes of FBSS are fibrosis and adhesions, spinal instability, recurrent herniated disk, and inadequate decompression. The purpose of this study is ...
Both CAPD-Y and CCPD have been reported to reduce the high peritonitis rate of conventional CAPD. As peritonitis was the major complication of CAPD in our centre, both modifications were introduced in 1987. Initially, treatment modalities were allocated to patients based on their (doctor's) preference. A remarkable difference in peritonitis rate was encountered between patients on CCPD and those on CAPD-Y (0.6 vs 1.2 episodes a year). As patient selection and doctor's preference might have contr ...
OBJECTIVE This study sought to show and analyze the main authors' experience (P.R. and J.M.C.) in previously coiled aneurysm surgery as an emerging challenge in today's neurosurgical practice. METHODS Twelve female and 8 male patients, whose ages ranged from 32 to 56 years (average 43.5), underwent surgery between April 2009 and September 2012 in 2 centers. Reasons for surgery were 13 partially occluded aneurysms and 7 recanalized aneurysms. RESULTS There was no mortality in this series. Ane ...
OPINION STATEMENT Rapid improvement in antineoplastic therapy is increasing not only cancer survivorship but also the incidence of end-stage heart failure among breast and childhood cancer survivors. Anthracyclines and newer targeted therapies, including trastuzumab and tyrosine kinase inhibitors, are important agents implemented in clinical practice that carry cardiotoxic risk. While acute heart failure is often self-limited and reversible, delayed-onset heart failure significantly reduces surv ...
BACKGROUND Endocavitary radiation therapy is an alternative to surgical therapy for some early rectal carcinomas. Careful patient selection is necessary to ensure good results. The purpose of this study was to examine the authors' experience with endocavitary radiation at their institution from 1984 to 1991 to determine which factors were associated with treatment failure to provide for better future patient selection. METHODS Thirty-two patients with carcinoma of the rectum, not apparently in ...
Combined modality staging is a methodology in which all of the pretreatment clinical factors that are found to have independent prognostic significance on multivariable analysis for predicting a given outcome (e.g., pathologic stage) are used to determine the initial management. This method of staging provides an optimized assessment of the pathologic extent of local disease prior to management, and therefore is better able to define those patients in whom local only therapy is likely to be cura ...
Forty patients who had normal-pressure hydrocephalus were examined neuropsychologically before and 12 months after a ventriculoatrial shunt operation. Comparison of the preoperative and postoperative test results showed that cognitive functions improved in 16 patients, were unchanged in 19, and deteriorated in 5. Moreover, we found that the outcome of the operation depended on patient selection criteria. When three or more of the following preoperative signs were present (known cause, short hist ...
  • L. Ellis, Daniel J. Hicklin,
  • Clinical cancer research : an official journal of the American Association for Cancer Research
  • 2009
The advent of targeted therapy for treatment of human cancers has added significantly to our armamentarium as we strive to prolong patient survival while minimizing toxicity. In cancers driven by a dominant oncogene, targeted therapies have led to remarkable improvements in response and survival, whereas in others the outcome has been more modest. One key aspect toward realizing the potential of targeted therapies is a better understanding of the intrinsic or acquired resistance mechanisms that ...
Three-dimensional conformal radiation therapy (3DCRT) has been shown to reduce normal tissue toxicity and allow dose escalation in the curative treatment of prostate cancer. The Faculty of Radiation Oncology Genito-Urinary Group initiated a consensus process to generate evidence-based guidelines for the safe and effective implementation of 3DCRT. All radiation oncology departments in Australia and New Zealand were invited to complete a survey of their prostate practice and to send representative ...
IN THE CURRENT ISSUE OF SURGERY, HernandezAlejandro et al report their experience in using an ALPPS approach (ie, associating liver partition with portal vein ligation for staged hepatectomy) with extended right hepatectomy in 14 patients with bilateral colorectal liver metastases. Their study is important for 2 reasons. First, the authors achieved a 90-day mortality rate of zero and a major complication rate (Dindo classification $ IIIA) of 21%, in contrast with the unacceptable mortality and m ...
The aims of the present study were to examine whether unresectable hepatocellular carcinoma (HCC) patients treated with initial dose of sorafenib of 400 mg/day (half-dose group) had comparable treatment efficacy, safety and survival merit as compared with those treated with initial dose of sorafenib of 800 mg/day (standard-dose group) in a multicenter large study. For reducing the bias in patient selection, we compared clinical outcomes of these two groups using propensity score matching analysi ...
BACKGROUND Patients with extensive brain infarcts are at increased risk for stroke-associated respiratory tract infections (SARTI), which cause worse outcome. The benefit of general antibiotic prophylaxis is controversial. Early diagnosis of SARTI may improve patient selection for antimicrobial therapy. Procalcitonin (PCT) is widely recognized as serum marker for bacterial infections. Its diagnostic value with respect to SARTI has not been assessed systematically. METHODS Serum PCT levels were ...
BACKGROUND Patients undergoing liver resection for colorectal cancer liver metastasis (CRCLM) are often treated with chemotherapy before surgery. However, the associations between chemotherapy, liver injury, perioperative outcomes, and other confounding factors remain unclear. This study investigates the effect of preoperative chemotherapy for CRCLM on nontumoral liver histology and perioperative outcomes in a contemporary cohort. STUDY DESIGN Five hundred six patients underwent hepatic resect ...
OBJECTIVE The use of prehospital needle thoracostomy (NT) is controversial as it is not without risk. Issues such as inappropriate patient selection, misplacement causing iatrogenic injury, treatment failures in obese patients, and delaying definitive tube thoracostomy in the emergency department contribute to this controversy. The purpose of this study is to evaluate a cohort of patients undergoing NT by paramedics for tension pneumothorax and review the indications for use, complications, and ...
A consecutive series of 7104 patients undergoing isolated coronary artery bypass grafting during an 18-year period (1971 to 1988) included 469 patients older than 75 years. Results were analyzed to determine comparative risk factors for morbidity, early and late survival, and functional outcome. Patients younger than 75 years (group I) and patients older than 75 years (group II) were identical for ejection fraction and standard hemodynamic indices. Mean number of grafts and crossclamp time were ...
Arthroscopic labral repair in the shoulder has become commonplace in recent years. A variety of implants have evolved in parallel with arthroscopic techniques. Any orthopedic implant that is placed in close proximity to the joint has the potential to cause subsequent damage to the articular surface if it is left prominent or dislodges secondary to improper surgical technique. This article focuses on a series of implant-related complications of labral surgery and their subsequent management. Addi ...
OBJECTIVE AND BACKGROUND The aim of the present study was to develop and validate a prediction score for postoperative complications by severity and guide perioperative management and patient selection in hepatitis B-related hepatocellular carcinoma patients undergoing liver resection. METHODS A total of 1543 consecutive liver resections cases were included in the study. Randomly selected sample set of 70% of the study cohort was used to develop a score to predict complications III-V and the r ...
CONTEXT The urinary reconstructive options available after radical cystectomy (RC) for bladder cancer are discussed, as are the criteria for selection of the most appropriate diversion, and the outcomes and complications associated with different diversion options. OBJECTIVE To critically review the peer-reviewed literature on the function and oncological outcomes, complications, and factors influencing choice of procedure with urinary diversion after RC for bladder carcinoma. EVIDENCE ACQUI ...
PURPOSE To analyze the effectiveness and toxicities in the re-irradiation of locally recurrent nasopharyngeal carcinoma (NPC) using intensity-modulated radiotherapy (IMRT). METHODS This is a retrospective analysis of 54 NPC patients with local recurrence re-irradiated with IMRT. The re-staging for rT1, rT2, rT3, rT4 were 3 (5.6%), 8 (14.8%), 9 (16.7%), 34 (63%) respectively. The average dose to GTV was 69.95 Gy (49.8-76.58 Gy), the average BED(3Gy) was 116.8 Gy (83.5-127.9 Gy). V₉₅ was 96% ...
Systemic amyloid light-chain (AL) amyloidosis is a protein conformation disorder caused by clonal plasma cell dyscrasias. Symptoms result from fibrillar extracellular deposits in various tissues. The deposits disrupt organ function and ultimately lead to death. The prognosis is poor and depends mostly on the severity of cardiac involvement. The treatment is derived from the therapy of multiple myeloma with the main goal being to reach a complete hematological remission (CR). High-dose melphalan ...
Over the years, policies adopted by United Network of Organ Sharing (UNOS) have directed allocation of donor hearts in the USA. These policies have been based on algorithms that allocate a higher priority status to those patients who are the most infirm, and would thereby benefit patients in the most dire of circumstances. Over the last 2 decades, the increased use of LVADs as a bridge to transplantation has had a major impact on lowering the mortality among those on the heart transplant waiting ...
INTRODUCTION Modern advances in endonasal endoscopic surgery have expanded its utility in the management of malignant sinonasal tumours, and the degree to which cases are eligible. Knowledge of the indications, inclusion and exclusion criteria and imaging workup that empowers judicious patient selection is essential. This article discusses the endoscopic resection of malignant sinonasal tumours. CONCLUSION Studies describing the impact of patient quality of life will surely affect the fate of ...
Minimally invasive laparoscopic wedge resection for gastric mucosal carcinoma and submucosal tumor was first performed in Keio University hospital in 1992. Since then, 172 gastric tumor patients, including four cases of carcinoid tumor, have been successfully treated at the Keio University hospital using this procedure. No local disease recurrence or distant metastases have been observed in follow-ups over as long as 10 years. Chronic atrophic gastritis patients with carcinoid tumors occurring s ...
BACKGROUND AND OBJECTIVES Single-port laparoscopic cholecystectomy may contribute to a paradigm shift in the field of laparoscopic cholecystectomy surgery by providing patients with benefits beyond those observed after other surgical procedures. This study was designed to evaluate clinically meaningful differences in operative outcomes between obese and nonobese patients after single-port laparoscopic cholecystectomy. METHODS Data were collected retrospectively from 172 patients who had underg ...
The Hydroflex penile prosthesis has been implanted in 100 patients with a 1 to 3 1/2-year followup. Patient dissatisfaction among the earlier implants was high due to inadequate girth and support during intercourse and difficulty with inflation and deflation of the device. As experience was gained in patient selection and sizing of the cylinders, patient satisfaction improved considerably. The mechanical reliability of this device has been good to date. ...
OBJECTIVE Between April 1994 and January 1999, 39 stereotactic procedures for patients with intractable tremor were performed at the University of Pittsburgh Medical Center. A retrospective analysis of results of radiosurgical thalamotomy (n = 15), MR-guided stereotactic radiofrequency thalamotomy (n = 13), and deep brain thalamic stimulation (DBS; n = 11) was performed to study relative advantages and risks of these procedures. METHODS All options were discussed with the patients, but radiosu ...
BACKGROUND Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a more stringent patient selection, mortality after hepatic resection has steadily decreased, but its incidence still ranges from 10% to 20%. The factors linked to postoperative liver failure in major hepatic resection in the modern era should be reevaluated. STUDY DESIGN Of 80 patients with viral markers (hepatitis C viral antibody or hep ...
Of 24 renal allograft recipients with urinary extravasation 14 (58%) with ureteral fistulas were selected for percutaneous management in an attempt to obviate secondary operative intervention. The initial procedure in all cases was placement of a percutaneous nephrostomy tube with subsequent internal or internal/external stenting. With a mean followup of 47 months, the percutaneous management proved definitive in 5 patients (36%) and palliative in 1 (7%). The other 8 patients (57%) subsequently ...
  • Vianney Wilson,
  • SADJ : journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging
  • 2009
An acrylic partial denture (APD) is one option for replacing missing teeth and is also the most cost effective treatment option. Dentists are faced with the demand for replacing missing teeth from patients with limited financial resources; therefore the replacement of missingteeth with an APD is a common occurrence. One of the disadvantages of APD's is its poor strength. Dentists and dental technicians tend to design and construct acrylic partial dentures with little or no tooth support. This ca ...
We read with great interest the article of Pereira et al ‘Surgical correction of Poland’s syndrome in males e a purposely designed implant’. In this article the authors wonderfully depict their experience of chest wall reconstruction in male patients with Poland anomaly with customised implants. Various options were described for chest wall reconstruction in male patients with Poland anomaly, including autologous techniques (latissimus dorsi muscle flap, fat tissue transfer), alloplastic m ...
Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is se ...
Since its description in 1981, the MAGPI procedure has rapidly assumed a major role in the repair of coronal and subcoronal hypospadias without chordee. Success with this procedure depends upon careful attention to detail and proper patient selection. Despite heeding these caveats the authors have noted occasional patients who, following completion of a MAGPI, have a disturbing "fishmouth" quality to the meatus. Herein is described a simple modification that seems to improve the cosmetic results ...
OPINION STATEMENT Organ preservation has been increasingly utilised in the management of muscle-invasive bladder cancer. Multiple bladder preservation options exist, although the approach of maximal TURBT performed along with chemoradiation is the most favoured. Phase III trials have shown superiority of chemoradiotherapy compared to radiotherapy alone. Concurrent chemoradiotherapy gives local control outcomes comparable to those of radical surgery, but seemingly more superior when considering q ...
Tyrosine kinase inhibitors that target the key molecular drivers of gastrointestinal stromal tumour (GIST) are effective treatments of advanced-stage GIST. Yet, most of these patients succumb to the disease. Approximately 60% of patients with GIST are cured by surgery, and these individuals can be identified by risk stratification schemes based on tumour size, mitosis count and site, and assessment of rupture. Two large randomized trials have evaluated imatinib as adjuvant treatment for operable ...
To determine the accuracy of double-contrast arthrography in complete rotator cuff tears, we studied 805 patients thought to have a complete rotator cuff tear who had undergone double-contrast shoulder arthrography (DCSA) between 1978 and 1983. The results of this study indicate that DCSA is exquisitely sensitive and as accurate as the single-contrast examination. The site of disruption was directly visualized in 93% of cases, and the size of the defect and status of the torn tendon edges were r ...
To define the short- and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization. We performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four variables on epidemiology, comorbidity, baseline status, vital signs, signs of con ...
  • B E Strober,
  • Seminars in cutaneous medicine and surgery
  • 2005
Etanercept is a tumor necrosis factor alpha (TNF-alpha) inhibitor approved for the treatment of psoriasis. Etanercept is a soluble version of the tumor necrosis factor receptor (TNFR) that neutralizes the proinflammatory activity of TNF-alpha, a molecule central to the pathogenesis of psoriasis. Patients receiving etanercept continuously during both 12 and 24 weeks show a significant reduction in the signs of psoriasis. Further, higher doses of etanercept provide better efficacy. Both clinical t ...
Rhinoplasty is performed in order to correct aesthetic deformities of the nose or to improve nasal breathing. A detailed knowledge of the complex three-dimensional anatomy, familiarity with the various rhinoplasty techniques and a well-developed aesthetic perception are essential for the success of this procedure. The fundamental requisites for rhinoplasty are outlined, i.e. anatomy of the nose, aesthetic considerations, essentials about patient selection, patient history and clinical examinatio ...
  • K. A. Ludwig,
  • Obstetrics and gynecology clinics of North America
  • 1998
Although the majority of patients with low-grade anal incontinence and constipation should be treated medically, for some, efforts will be unsuccessful and surgical therapy will be in order. Full thickness rectal prolapse will, in all early cases, be treated surgically. This article outlines the surgical treatment options for patients with anal incontinence, rectal prolapse, and constipation. Optimal functional outcomes with surgical treatment are based on full physiologic evaluation and careful ...
Total knee arthroplasty (TKA) is commonly considered to be a reliable procedure, with implant survival rates higher than 90% at 10 to 15 years of follow-up. The goal of total knee replacement surgery is to relieve pain and obtain better knee function, those achieved by correct patient selection, pre-operative deformity, implant design, correct surgical technique and patient participation in the rehabilitation protocol (Nizard et al, 2002). Several technical requirements during TKA are important ...
BACKGROUND Although the lateral thoracodorsal fasciocutaneous flap is a well-studied procedure for late breast reconstruction following radical surgery, there are few previous reports regarding its indication, flap design, and clinical outcome following conservative breast surgery. METHODS Thirty-four patients underwent immediate unilateral lateral thoracodorsal fasciocutaneous flap breast reconstructions. Mean time of follow-up was 23 months. The lateral thoracodorsal fasciocutaneous flap was ...