Paediatric urology

2020 ◽  
pp. 709-760
Author(s):  
Suzanne Biers ◽  
Noel Armenakas ◽  
Alastair Lamb ◽  
Stephen Mark ◽  
John Reynard ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Nursing Staff ◽  
Ambiguous Genitalia ◽  
Paediatric Surgery ◽  
Management Options ◽  
Surgical Specialty ◽  
Paediatric Urology ◽  
Testis Torsion ◽  
Paediatric Nephrologist

Paediatric urology is a sub-specialty derived from urology and paediatric surgery. It is generally an elective surgical specialty with few acute conditions. Development of a good team incorporating a paediatric nephrologist, a radiologist, and a pathologist assists in the clinical diagnosis, management options, and follow-up. A paediatric anaesthetist and skilled experienced and compassionate nursing staff are essential to manage the children. This chapter covers the foreskin and circumcision, undescended testes and testis torsion, hypospadias, abnormalities of the urethra, ambiguous genitalia, and malignancies of the genitourinary tract.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

A Qualitative Study of Developing Competency in Thyroid Surgery: A Resident’s Perspective With 5 Year Follow Up

2021 ◽  
pp. 000348942199691
Author(s):  
Gabriela DeVries ◽  
Megan Rudolph ◽  
Howard David Reines ◽  
Philip E. Zapanta
Keyword(s):  
Qualitative Study ◽  
Learning Strategies ◽  
Thyroid Surgery ◽  
Washington Dc ◽  
Structured Interviews ◽  
Self Directed Learning ◽  
Surgical Specialty ◽  
Long Term Follow Up ◽  
The Individual

Objectives: The Accreditation Council for Graduate Medical Education has guidelines on assessing surgical qualifications based on experience. Attending surgeons have various assumptions on how their trainees learn and acquire surgical skills. This study primarily investigates the resident’s perspective on gaining experience and achieving competency in thyroid surgical procedures. Methods: A qualitative study using semi-structured interviews was designed to derive themes that discuss the acquisition of competency in thyroid surgery. After IRB approval, data was collected from 2012 to 2014 at 4 academic centers in the Washington, DC area. Fourteen chief residents specializing in either general surgery or otolaryngology were interviewed until saturation was achieved. These semi-structured interviews were transcribed and broken up into codes utilizing Moustakas’ analysis. A comprehensive list of master themes in regards to achieving competency in thyroid surgery was developed. A follow up survey of the surgeons was undertaken at 5 years to determine if the perceptions during residency persisted in practice. Results: Surgical specialty residents experience and learn thyroid surgery in 5 learning themes: 1. Self—directed learning is significant during residency. 2. Repetition with graduated autonomy is key. 3. Effective mentors are competent surgeons who challenge residents and use positive teaching techniques. 4. Residents employ active learning through the “see one, do one, teach one” philosophy. 5. Learning from complexity is of importance to residency training. After several years in practice, the most important theme in learning after residency was repetition of cases. Conclusions: This study demonstrates how residents progress in approaching competency in thyroid surgery. Adult learning strategies are preferred, and programs should incorporate tailored techniques to meet the individual needs of the residents. Perceptions of what is most important shifted in long-term follow up. Further study is needed to assure competency in residency and in practice.

scholarly journals Diagnostic accuracy of imaging brain vesicular monoamine transporter type 2 (VMAT2) in clinically uncertain parkinsonian syndrome (CUPS): a 3-year follow-up study in community patients

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e025533 ◽  
Author(s):  
San San Xu ◽  
Paschal K Alexander ◽  
Yenni Lie ◽  
Vincent Dore ◽  
Svetlana Bozinovski ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Pet Scan ◽  
Vesicular Monoamine Transporter ◽  
Monoamine Transporter ◽  
Rubral Tremor ◽  
Diagnostic Changes ◽  
Community Patients

ObjectivesTo further validate the diagnostic utility of 18F-AV-133 vesicular monoamine transporter type 2 (VMAT2) positron emission tomography (PET) in patients with clinically uncertain parkinsonian syndromes (CUPS) by comparison to clinical diagnosis at 3 years follow-up.Design, setting and participantsIn a previous study, we reported that 18F-AV-133 PET in community patients with CUPS changed diagnosis and management and increased diagnostic confidence. The current diagnosis of this cohort was obtained from the patient and treating specialist and compared with the diagnosis suggested 3 years earlier by the 18F-AV-133 PET. A second 18F-AV-133 PET was available in those with a discordant or inconclusive final diagnosis.Study outcome measuresThe primary end point was the proportion of patients who had a follow-up clinical diagnosis, which was concordant with their initial 18F-AV-133 PET scan. Secondary end points were the proportion of patients who had the same diagnosis at follow-up as that reached after the initial scan and the stability of diagnostic changes made after the first scan.Results81 of the 85 patients previously recruited to the CUPS study had follow-up of which 79 had a clinical diagnosis and 2 remained CUPS. The diagnosis was in agreement with the initial 18F-AV-133 PET scan result in 74 cases. Five patients had a discordant diagnosis; one patient with rubral tremor had a severely abnormal scan that had worsened when rescanned; four cases with normal initial and repeat scans had a clinical diagnosis of Parkinson’s disease. Two patients with suspected genetic disorders remained classified as CUPS and both had normal scans. In the 24 CUPS cohort patients where 18F-AV-133 PET initially changed diagnosis, this change was supported by follow-up diagnosis in all but the one rubral tremor case.Conclusion18F-AV-133 PET is a useful tool in improving diagnostic accuracy in CUPS providing results and diagnostic changes that remain robust after 3 years follow-up.

scholarly journals Cerebellar hemangioblastoma during pregnancy: Management options and review of literature

2020 ◽  
Vol 11 ◽  
pp. 123
Author(s):  
Nitish Nayak ◽  
Anil Kumar
Keyword(s):  
Obstructive Hydrocephalus ◽  
Mass Effect ◽  
Lateral Position ◽  
Management Options ◽  
Cerebellar Hemangioblastoma ◽  
Suboccipital Craniotomy ◽  
History Of ◽  
Nerve Paresis ◽  
Csf Diversion

Background: Symptomatic cerebellar hemangioblastomas are extremely rare in pregnant women and the ideal management is not well established. In the present article, we aimed to report a case of large cerebellar hemangioblastoma complicated by pregnancy and managed successfully by surgical resection. In addition, we also discuss management options and review of the current literature pertaining to this pathology. Case Description: A 22-year-old female presented with a history of headache and vomiting for 4 weeks. She was carrying 28 weeks of pregnancy. She had left cerebellar signs, gait ataxia, and bilateral six nerve paresis. Fundus examination revealed bilateral papilledema. She was diagnosed to have large cerebellar hemangioblastoma with mass effect and obstructive hydrocephalus. She underwent suboccipital craniotomy and excision of lesion in lateral position. She recovered well postoperatively and delivered a healthy baby in the full term. Imaging at10- month follow-up demonstrates no residual lesion or another hemangioblastoma. Conclusion: Early diagnosis and direct surgery for excision of hemangioblastoma is a good option during pregnancy while avoiding CSF diversion procedures. The symptomatic hemangioblastoma during pregnancy can be safely operated during early pregnancy.

scholarly journals Is there a role for warfarin anymore?

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 541-546 ◽  
Author(s):  
Alan Jacobson
Keyword(s):  
Bleeding Risk ◽  
Novel Agents ◽  
The Novel ◽  
Management Options ◽  
Health Care Outcomes ◽  
Routine Clinical Setting ◽  
Hemorrhagic Risk ◽  
Care Outcomes ◽  
Effective Use

Abstract Reduction of atrial fibrillation–associated stroke risk has become the leading indication for warfarin use. Optimal management of warfarin can only be achieved with a relatively complex infrastructure. Alternative anticoagulant agents have been developed, and 3 have demonstrated effectiveness, safety, and adherence that are comparable or superior to warfarin in the clinical trial setting. None of the novel agents requires routine laboratory testing to demonstrate effective anticoagulation. Whereas these new agents present potential advantages, such as fixed dosing and dramatically reduced intracranial hemorrhaging, they are also subject to caveats that ought to be considered in the context of an “ideal” anticoagulant. If used casually, they have the potential to worsen rather than improve health care outcomes. There is little question that the management burden of the novel agents will be less than with warfarin. However, with a hemorrhagic risk that was similar to warfarin in these trials, there will likely remain a significant need for both baseline education and some level of focused interval follow-up to assess for bleeding risk and adherence considerations. These novel agents offer a definite advance in the available management options for thromboembolic disease, but until we understand the requirements for safe and effective use in the routine clinical setting, we will not be able to establish the extent to which they should replace warfarin.

Blood amyloid β oligomerization as a biomarker of Alzheimer’s disease: a blinded validation study

2020 ◽  
Author(s):  
Young Chul Youn ◽  
Byoung Sub Lee ◽  
Gwang Je Kim ◽  
Ji Sun Ryu ◽  
Kuntaek Lim ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Sensitivity And Specificity ◽  
Detection System ◽  
Amyloid Β ◽  
High Sensitivity ◽  
Community Based ◽  
Clinical Sensitivity ◽  
Aβ Oligomerization ◽  
Normal Cognition

Abstract INTRODUCTION: Oligomeric amyloid ß (Aß) is one of the major contributors to the pathomechanism of AD; Aß oligomerization in plasma can be measured using a Multimer Detection System-Oligomeric Aß (MDS-OAß) after incubation with spiked synthetic Aß. METHODS: We evaluated the clinical sensitivity and specificity of the MDS-OAß values by inBlood TM OAß test using heparin-treated plasma samples from 52 AD patients in comparison with 52 community-based subjects with normal cognition (NC). The inclusion criterion was proposed by the NINCDS-ADRDA and additionally required for the least 6 months of follow-up from the initial clinical diagnosis in the course of AD. RESULTS: The MDS-OAβ values were 1.43 ± 0.30 ng/ml in AD and 0.45 ± 0.19 ( p <0.001) in NC, respectively. Using a cut-off value of 0.78 ng/ml, the results revealed that 100% sensitivity 92.31% specificity. DISCUSSION: MDS-OAß to measure plasma Aβ oligomerization is a valuable blood-based biomarker for clinical diagnosis of AD, with high sensitivity and specificity.

Introduction

2020 ◽  
pp. 1-10
Keyword(s):  
United Kingdom ◽  
Surgical Care ◽  
Second World War ◽  
British Association ◽  
Paediatric Surgery ◽  
World War ◽  
Surgical Specialty ◽  
The United Kingdom ◽  
Second World

Paediatric surgery is the surgical care of children from fetus to adolescent. It is a comparatively new surgical specialty, only formally recognized after the Second World War. This chapter provides a history and overview of the specialty, including the associations related to paediatric surgery, and biographies of famous surgeons who contributed to the field throughout their careers. The main organization in the United Kingdom is the British Association of Paediatric Surgeons (BAPS) founded in 1953 with Sir Denis Browne as the first president. Though based in London, it now has many international contacts and, through its conferences and symposia inside and outside the United Kingdom, is a leading educational provider in the specialty.

scholarly journals Analysis and Follow up of Endoscopy Results in 1099 Patients with Terminal Ileum Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Qinglian Zhong ◽  
Anye Zhang ◽  
Jian Huang ◽  
Wen Yan ◽  
Jiayu Lin ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Diagnostic Accuracy ◽  
Clinical Diagnosis ◽  
Terminal Ileum ◽  
Diagnostic Yield ◽  
Delayed Diagnosis ◽  
Clinical Treatment ◽  
Diagnosis And Management

Objective. We aim to analyze the diagnostic yield, diagnostic accuracy, and delayed diagnosis of patients with terminal ileum lesions, providing follow-up suggestions for suspected patients. Methods. We carried out an analysis of 1099 patients who had terminal ileum lesions in our hospital from 2009 to 2019. The endoscopy reports and histopathology reports of terminal ileal biopsies were recorded. Clinical diagnosis and management were reviewed to determine whether there was a need to correct after a follow-up endoscopy result. Results. A total of 1099 patients were found to have terminal ileum lesions, among which 959 in 1099 patients (87.26%) were diagnosed as benign, 17 in 1099 patients (1.55%) were diagnosed as malignant, and 123 in 1099 patients (11.19%) were diagnosed as suspected. The diagnostic accuracies of terminal ileal polyp, cyst, cancer, eosinophilic enteritis, parasite, lymphofollicular hyperplasia, and amyloidosis were 100%. The diagnosis was delayed in 9.93% of Crohn’s disease (CD) and 12.5% of lymphoma. Among the definite cases, the diagnosis was corrected during the follow-up in 12.5% of the patients, while the clinical treatment was corrected during the follow-up in 17.86% of the patients. Among the suspected cases, the diagnosis and treatment was corrected in 61.11% of the patients during the follow-up. Conclusion. Coincident diagnosis of ileitis and ileum ulcer is low. Delayed diagnosis of Crohn’s disease and lymphoma were observed in a certain proportion of patients with terminal ileum lesions. A follow-up endoscopy was strongly recommended for these suspected patients with terminal ileum lesions.

Increasing Handwashing in an Intensive Care Unit

1986 ◽  
Vol 7 (5) ◽  
pp. 259-262 ◽  
Author(s):  
Joni A. Mayer ◽  
Patricia M. Dubbert ◽  
Mary Miller ◽  
Paul A. Burkett ◽  
Stanley W. Chapman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Staff ◽  
Control Unit ◽  
Hospital Staff ◽  
Dependent Measure ◽  
Systematic Evaluation ◽  
Experimental Unit ◽  
Baseline Levels

AbstractThe present study provides the first systematic evaluation of strategies for increasing handwashing of hospital staff. Nursing staff on two intensive care units (ICUs) were observed over a 3-month period. After baseline observations, two interventions were implemented on the experimental unit: 1) changing to an emollient handwashing agent, and 2) providing feedback to staff about the frequency of handwashing. Feedback focused on the previous day's handwashing following completed patient contacts, interrupted patient contacts, and critical procedures. No increase in handwashing was observed following introduction of the emollient soap. However, when feedback was provided on the experimental ICU, handwashing following completed patient contacts (the major dependent measure) increased to 92%, and was significantly higher than handwashing on the control unit. Follow-up observations suggested that compliance on the experimental unit appeared to return to baseline levels.

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