Ileal Conduit and Continent Ileocecal Pouch for Patients Undergoing Pelvic Exenteration: Comparison of Complications and Quality of Life

2011 ◽  
Vol 21 (2) ◽  
pp. 403-408 ◽  
Author(s):  
Dirk Michael Forner ◽  
Björn Lampe

Objectives:Creating a continent urinary pouch has become an alternative to the ileal conduit for patients undergoing exenteration for advanced gynecologic malignancies. The objective of this study was to compare clinical outcomes for the 2 methods.Methods:In this retrospective study, we compared intraoperative and postoperative complications and quality-of-life scores for the modified ileocecal pouch and the ileal conduit in anterior or total pelvic exenteration.Results:In 33 of 100 patients, an ileal pouch (IP) was created; the other 67 were treated by an ileal conduit (IC). Creating an IP prolonged the exenterative procedure by 97 minutes compared to an IC (IC, 453 minutes vs IP, 550 minutes;P= 0.009). Overall complication rates were similar, but patients with an IP had significantly more complications of urinary diversion (48%) than patients with an IC (31%;P= 0.03). Follow-up showed urinary loss and frequency of micturition to be comparable, but in patients with an IP, surgery for stomal complications (n = 2) and treatment of bladderstones were necessary more frequently (n = 3). Quality of life according to the 12-item Short Form Health Survey questionnaire was similar in both groups.Conclusion:A continent IP is an alternative to the IC in cases of pelvic exenteration. Early complications are more frequent with an IP than with an IC. The mode of urinary diversion has little influence on the quality of life in patients with advanced genital cancer.

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 967-974 ◽  
Author(s):  
Christoph Schwartz ◽  
Thomas Pfefferkorn ◽  
Caroline Ebrahimi ◽  
Caroline Ottomeyer ◽  
Gunther Fesl ◽  
...  

Abstract BACKGROUND: Detailed data on long-term functional outcome of patients with World Federation of Neurosurgical Societies (WFNS) grades IV and V aneurysmal subarachnoid hemorrhages (aSAH) are still scarce. OBJECTIVE: Assessment of long-term outcome of WFNS IV and V aSAH patients. METHODS: Functional outcome and quality of life were assessed by the modified Rankin scale (mRS) and the 36-item short-form health survey in consecutively treated aSAH WFNS IV and V patients between 2005 and 2010. Scores from the 36-item short-form health survey were compared to a healthy German population. Prognostic factors were analyzed by uni- and multivariate models. RESULTS: One hundred and seven eligible patients (median age: 53.0 years) were identified. After interdisciplinary consensus on optimal treatment, aneurysms were obliterated either by clipping (n = 35) or by coiling (n = 72). Ten patients were lost to long-term follow-up; the median clinical follow-up period was 3.2 years for the remaining 97 cases. Twenty-five of 97 died during the acute hospital phase and another 10 patients over the follow-up period leaving 62 long-term survivors. At the end of clinical follow-up, 40/97 patients, including 40/62 of long-term survivors, reached functional independence (mRS ≤ 2). Twelve of 97 patients were moderately (mRS = 3), 10/97 patients were severely disabled (mRS ≥ 4). Younger age (≤ 53 years; P = .001) and radiological absence of cerebral infarction (P = .03) were the strongest predictors for favorable outcome. Quality of life was perceived to be only moderately reduced compared to the healthy control group. CONCLUSION: Poor-grade aSAH is not necessarily associated with poor long-term functional outcome; after aneurysm repair ∼60% of patients survived and among long-term survivors ∼ 60% regained functional independence.


2017 ◽  
Vol 7 (2) ◽  
pp. 170-178 ◽  
Author(s):  
Alisson R. Teles ◽  
Tobias A. Mattei ◽  
Orlando Righesso ◽  
Asdrubal Falavigna

Study Design: Systematic review. Objective: There is a need for synthesizing data on effectiveness of treatments for patients with adult spinal deformity (ASD) due to its increasing prevalence and health care costs for these patients. The objective of this review was to estimate the effectiveness of surgery versus nonoperative care in patients with ASD. Methods: A systematic review of articles in published in English using PubMed between 2005 and 2015. Surgical and nonsurgical series that reported baseline and follow-up health-related quality of life measures of patients with ASD with a minimum 2 years of follow-up were selected. Independent extraction of articles by 2 authors using predefined data fields, including risk of bias assessment. Results: Surgery significantly reduces disability, pain, and improves patients’ quality of life. The average postoperative improvement in Oswestry Disability Index was −19.1 (±9.0), Numerical Rating Scale back pain −4.14 (±1.38), Numerical Rating Scale leg pain −3.36 (±1.33), Short-Form Health Survey 36-SF36-Physical Component score 11.2 (±5.07), and Short-Form Health Survey 36-Mental Component score 9.93 (±4.96). The complication rate ranged from 9.52% to 81.52% (mean = 39.62%), and the need for revision surgery ranged from 1.72% to 40.0% (mean = 15.71%). The best existing evidence about nonoperative care of ASD is provided from observational studies with very high risk of bias. Quantitative analyses of nonsurgical cohorts did not demonstrate significant changes in quality of life of patients after 2 years of observation. Conclusions: This data may assist clinicians to counsel patients, as well as to inform health care providers and policymakers about what to expect from the treatment for ASD.


Author(s):  
Loay Shoubash ◽  
Jörg Baldauf ◽  
Marc Matthes ◽  
Michael Kirsch ◽  
Matthias Rath ◽  
...  

AbstractThe aim of this study is to analyze the long-term quality of life after surgery of cavernoma. A monocentric retrospective study was conducted on 69 patients with cavernoma treated microsurgically between 2000 and 2016. The eloquence was adopted from Spetzler-Martin definition. A most recent follow-up was elicited between 2017 and 2019, in which the quality of life (QoL) was evaluated with the Short Form-12 questionnaire (SF12). Forty-one lesions were in eloquent group (EG), 22 in non-eloquent group (NEG), 3 in orbit, and 3 in the spinal cord. Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. Regarding QoL assessment of 44 patients (EG n = 27, NEG n = 14) attended the last follow-up. Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. However, they reported general health perception inferior to norms, which was affected by the limited physical and emotional roles. At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. These results add value for decision-making as well as patient counseling for future encountered cases. Preoperative evaluation of QoL is recommended for future studies to assess QoL dynamics.


2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Chadia Haddad ◽  
Hala Sacre ◽  
Sahar Obeid ◽  
Pascale Salameh ◽  
Souheil Hallit

Abstract Background In clinical practice, quality of life measures can be used alongside some types of assessment to give valuable information that can identify areas that influence an individual and help the clinician make the best healthcare choices. This study aimed to investigate the psychometric properties of the Arabic version of the 12-item short-form health survey (SF-12) in a sample of Lebanese adults. Methods This cross-sectional study performed between July and November 2019 recruited 269 participants. Cronbach’s alpha was used to assess the reliability of the SF-12 questionnaire, and a factor analysis using the principal component analysis was performed to confirm its construct validity. Results The mean score for the “physical component summary (PCS-12)” was 50.27 ± 8.94 (95 % CI: 49.18–51.36) and for the “Mental component summary (MCS-12)” was 44.95 ± 12.17 (95 % CI: 43.47–46.43). A satisfactory Cronbach’s alpha was found for the two components: MCS (α = 0.707) and PCS (α = 0.743). The principal component analysis converged over a two-factor solution (physical and mental), explaining a total variance of 55.75 %. Correlations between the SF-12 scales and single items were significant, showing a good construct validity. The “physical functioning”, “role physical”, “bodily pain”, and “general health” subscales were highly associated with “PCS-12”, while the “vitality”, “social functioning”, “role emotional”, and “mental health” subscales were more associated with MCS-12. Conclusions The Arabic version of the SF-12 is a reliable, easy-to-use, and valid tool to measure health-related quality of life in the general population. Future studies using a larger sample size and focusing on questionnaire psychometric properties are necessary to confirm our findings.


2006 ◽  
Vol 10 (01) ◽  
pp. 47-55 ◽  
Author(s):  
Boonsin Tangtrakulwanich ◽  
Virasakdi Chongsuvivatwong ◽  
Alan F. Geater

Objective: To identify what extent different patterns and severities of involvement affect quality of life of people suffering knee osteoarthritis. Methods: This population-based survey involved 288 women and 288 men aged 40 years or older from Songkhla province, southern Thailand. Quality of life was measured using the Medical Outcome Study Short Form Health sutvery (SF-36) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic investigation included antero-posterior and skyline view of both knees. Osteoarthritis was categorized into 3 patterns; isolated patellofemoral, isolated tibiofemoral and combined with diagnosis based on Kellgren & Lawrence grade 2 or higher. Results: Quality of life as measured by SF-36 and WOMAC showed poorer score in moderate or severe grade than in mild grade of severity. Isolated patellofemoral and combined patterns demonstrated showed poorer scores on both WOMAC and SF-36 than isolated tibiofemoral pattern. Body mass index, income level and pattern of involvement could independently predict total scores of WOMAC, while age, marital status and pattern of involvement affected total score of SF-36. Conclusion: Pattern of involvement is a better predictor of quality of life than disease severity in patients with knee osteoarthritis.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Joan M ODonnell ◽  
Maurizio Manuguerra ◽  
Jemma L Hodge ◽  
Greg Savage ◽  
Michael K Morgan

Background: Studies have questioned the effectiveness of surgery for the management of unruptured intracranial aneurysm (uIA). Few studies have examined the ability to drive and quality of life (QOL) after surgery for uIA. Objective: This study examined the effectiveness of surgical management of uIA by measuring patients’ perceived quality of life and their cognitive abilities related to driving. Methods: Between January 2011 and January 2016 patients with a uIA were assessed using the Quality Metric Short Form 36 (SF36) and the off-road driver screening instrument DriveSafeDriveAware. Reassessments were conducted at the 6-week post-operative follow-up for surgical patients and at 12-month follow-up for surgical and conservatively managed patients. Results: 175 patients enrolled in the study, of which 112(66%) had surgical management of their aneurysm. For the surgical cases who completed all assessments (N=74), there was a trend for the DriveSafe pre-operative mean score of 108 (SD 10.7) to be lower than the 6-week and 12-month post-operative mean scores (111 SD 9.7 and 112 SD 10.2 respectively)(p=0.05). There were no significant changes in DriveAware scores at any epoch or between patient groups nor in the MCS in the surgical group.. There was a significant decline in PCS scores at 6 weeks post-operatively which recovered at 12 months (52 SD 8.1, 46 SD 6.8 and 52 SD 7.1 respectively)( p <0.01). There was no significant difference in 12-month mRS scores between the surgical cases who completed with cases who did not complete all assessments. Conclusion: Surgery for uIA did not affect cognitive abilities for driving at 6 weeks or 12 months after surgery. There was a decline in the QOL in the first months after surgery, however QOL returned to pre-surgical status 12 months after surgery. If the risk of seizures is low and there are no post-operative complications, returning to driving can be recommended.


2017 ◽  
Vol 16 (4) ◽  
pp. 283-287
Author(s):  
Thiago Kolachinski Brandão ◽  
André Nunes Machado ◽  
Bruno Vieira Moter ◽  
Adriano Masayuki Yonezaki ◽  
Fabrício Hidetoshi Ueno ◽  
...  

ABSTRACT Objective: To perform a prospective analysis of the quality of life prognostic factors in patients undergoing lumbar discectomy after two years of the procedure, relating the tools Short Form Health Survey, Roland Morris, Oswestry Disability Index, and VAS. Methods: Seventy-two patients were evaluated through the questionnaires in the preoperative, and one month, six months, one year and two years in the postoperative period, being performed lumbar discectomy after failure of conservative treatment. Results: We observed an improvement in comparative analysis during follow-up regarding baseline values. Conclusion: The domains social aspect, pain, general state, emotional aspect, mental health and vitality presented an improvement from the first month after the surgery; however, the domain functional capacity only showed significant improvement after 6 months and the physical aspects only after one year. Roland-Morris and VAS scales improved after one month after surgery, but Oswestry scale showed that for the measured aspects there was only improvement after six months of surgery.


2016 ◽  
Vol 26 (63) ◽  
pp. 63-70 ◽  
Author(s):  
Aline Moraes da Silva ◽  
Liliana Andolpho Magalhães Guimarães

Abstract To reduce the work related to stress and the psychosocial risk is not only an imperative question, but also moral. This epistemological study aims to verify the presence of the occupational stress and quality of life related to health in nursing professionals. We used three questionnaires: (a) Socio Demographic Questionnaire, (b) Job Strain Scale, and (c) Item Short Form Health Survey. Statistical analysis was performed between the questionnaires, analysis of variance (ANOVA) and simple and multiple linear regression. It was found that 60.8% of the participants see the high demand of work, 71.8% high control on the developed activity and 85.5% low social support. Related to eight dominant of quality of life, the most damaged are: pain (µ = 61.87) and vitality (µ = 62.25). It was concluded that although in most sample experiences an intermediary risk situation to stress, the quality of life showed a damaged.


2014 ◽  
Vol 41 (1) ◽  
pp. 018-022 ◽  
Author(s):  
Wilson Cintra Júnior ◽  
Miguel Luiz Antonio Modolin ◽  
Rodrigo Itocazo Rocha ◽  
Thadeu Rangel Fernandes ◽  
Ariel Barreto Nogueira ◽  
...  

OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL) in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.


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