scholarly journals The relationship between lymphedema severity and awareness of lymphedema surgery

2021 ◽  
Vol 48 (5) ◽  
pp. 534-542
Author(s):  
Hyun Seung Lee ◽  
Yong Chan Bae ◽  
Su Bong Nam ◽  
Chang Ryul Yi ◽  
Jin A Yoon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Indocyanine Green ◽  
Upper Extremity ◽  
Surgical Techniques ◽  
Cancer Center ◽  
Limited Knowledge ◽  
Early Stages ◽  
Md Anderson ◽  
The Relationship

Background During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients’ awareness of surgical treatment for secondary upper extremity lymphedema (UEL).Methods Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups.Results Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P<0.05) and more frequently underwent physiologic procedures than excisional procedures (P=0.003).Conclusions If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.

scholarly journals Pediatric Tracheotomy: Comparison of surgical technique with early and late complications in 273 cases

2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Murat Gumussoy
Keyword(s):  
Surgical Technique ◽  
Surgical Techniques ◽  
Skin Incision ◽  
Late Complications ◽  
Skill Level ◽  
Intubation Time ◽  
Early Complications ◽  
Creative Commons ◽  
Significant Difference ◽  
The Relationship

Objectives: This study was aimed to compare the early and late complications of tracheotomy in pediatric patient, with respect to surgical techniques. Methods: The relationship between demographic characteristics, surgical techniques obtained from the files of the children and complications developing after surgery were compared retrospectively. Results: One hundred fifty two out of 273 developed complications after tracheotomy. Among these, 75 were early complications and 77 were late complications. Results obtained concerning early complications showed a significant difference between Skin incision and Bleeding and Accidental decannulation; Tracheal incision and Subcutaneous emphysema; surgical time and accidental decannulation and tube/ventilation problem; Surgeon’s skill level and bleeding. As regards late complications there was a significant difference between Intubation Time and Stomal-tracheal granulation; Tracheal incision and Stomal infection; Surgeon’s skill level and Stomal-tracheal granulation. Conclusions: In pediatric tracheotomy the preferred skin incision and tracheal incision, surgeon’s experience, tracheotomoy time and intubation time are important as regards development of early or late complications. How to cite this:Gumussoy M. Pediatric Tracheotomy: Comparison of surgical technique with early and late complications in 273 cases. Pak J Med Sci. 2019;35(1):247-251. doi: https://doi.org/10.12669/pjms.35.1.132 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Surgical Technique for fixation of posterior root tears of the lateral meniscus and anterior cruciate ligament ruptures in acute lesions: Short-term clinical outcome

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0019
Author(s):  
Germán A. Jaramillo ◽  
Rubén D. Arias ◽  
Esteban Arrubla ◽  
Natalia Valencia
Keyword(s):  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Surgical Technique ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Surgical Techniques ◽  
Case Series ◽  
Activity Level ◽  
Acl Rupture ◽  
Anterior Cruciate

Background: Injuries of posterior lateral meniscus root (PLMR) are related to an acute trauma mechanism, which is commonly associated with anterior cruciate ligament (ACL) rupture. Many biomechanical studies have exposed the importance of the integrity of PLMR. There are several surgical techniques for its treatment, but is still controversial about which is the most appropriate, especially for combined injuries. Objective: To describe the clinical outcomes of patients with a surgical treatment of PLMR tear combined with ACL rupture Methods: Prospective case series. With patients who undergone repair of PLMR tears with ACL rupture, from 2016 to 2017 in a specialized hospital in Medellín city. Clinical evaluation it was determinate with Lysholm and IKDC (International Knee Documentation Committee) scores, before and one year after the surgical procedure. The paired sample t-test was applied to compare the results of the scores. Results: Six patients with acute lesion of PLMR tear combined with ACL rupture received treatment with a variation in the transtibial fixation of the PLMR surgical technique. Statistically significant differences were found when comparing the two scores before and after surgery (p=<0.05). In addition, no additional surgical interventions were performed in the follow-up time. Conclusion: The combined surgical treatment of PLMR and ACL injuries can be performed safely. This surgical technique provided an improvement in function, pain and activity level, which may help to delay the progression of osteoarthritis of the knee.

Copper transporter CTR1 expression and tissue platinum concentration in NSCLC.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2601-2601
Author(s):  
Deepak Kilari ◽  
XiMing Tang ◽  
Chi-Wan Chow ◽  
Junya Fujimoto ◽  
Neda Kalhor ◽  
...  
Keyword(s):  
Tumor Response ◽  
Causative Factor ◽  
Cancer Center ◽  
Nsclc Tissue ◽  
Copper Transporter ◽  
Md Anderson ◽  
Nsclc Patients ◽  
The Relationship ◽  
Larger Sample ◽  
Expression Score

2601 Background: Platinum (Pt) resistance is a major limitation in the treatment of advanced non-small cell lung cancer (NSCLC). We previously demonstrated that low tissue Pt concentration in NSCLC tumor specimens was significantly associated with reduced tumor response and worse survival. Furthermore, low expression of the copper transporter CTR1, a transporter of Pt uptake is reported to be associated with poor clinical outcome following Pt-based therapy in NSCLC patients. However, a defect in CTR1expression as a causative factor in reduced Pt accumulation in NSCLC tissues is not well-established. We investigated the relationship between tissue Pt concentrations and CTR1 expression in NSCLC specimens. Methods: We identified paraffin-embedded NSCLC tissue blocks from 30 patients who underwent neoadjuvant Pt-based chemotherapy with known tissue Pt concentrations at MD Anderson Cancer Center. Expression of CTR1 was determined by immunohistochemistry with adequate controls; 0 = undetectable; 1+ = barely detectable staining; 2+ = readily appreciable staining; and 3+ = dark brown staining. Pt concentration was compared between different CTR1 expression groups. Results: Tissue Pt concentration significantly correlated with tumor response in 30 patients who received neoadjuvant Pt-based chemotherapy (P<0.001). There was an uneven distribution of CTR1 expression scores with a majority of specimens demonstrating scores of 2+ (N=15, 50%). There were 2 specimens with no detectable CTR1 expression (score of 0) and 6 patients with a score of 3+. Patients with undetectable CTR1 expression in their tumors had significantly lower Pt concentrations compared to those with scores of 3+ (P=0.014). Furthermore, those with undetectable CTR1 expression had reduced tumor response compared to those with scores of 3+ following Pt-based chemotherapy (P=0.039). Conclusions: To the best of our knowledge, this is the first study to correlate CTR1 expression in clinical specimens to both tumor Pt uptake and response. Patients with undetectable CTR1 expression in their tumors had significantly lower Pt concentration and reduced tumor response. Further evaluation with a larger sample size is required. (Supported by 2012 ASCO Young Investigator Award)

Characteristics of asymmetric cleft lip and palate surgical treatment

2021 ◽  
Vol 21 (1) ◽  
pp. 23-31
Author(s):  
Yu. S. Rogozhina ◽  
S. I. Blokhina ◽  
E. S. Bimbas
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Maxillofacial Surgery ◽  
Surgical Techniques ◽  
Correct Choice ◽  
Good Cosmetic ◽  
Reasonable Choice ◽  
Positive Results

Relevance. The correct choice of the surgical technique for the treatment of the congenital asymmetric cleft lip and palate ensures the effectiveness of rehabilitation of patients with this pathology. The purpose is to present the results of the authors’ techniques for the surgical treatment of children with asymmetric cleft lip and/or palate.Materials and methods. Medical records of 687 children treated in 2015-2019 years were retrospectively analyzed at the clinic of maxillofacial surgery “Bonum” MСMC. The prevalence of asymmetric cleft lip and palate in children was determined. The prospective observation group included 84 patients with asymmetric cleft lip and/or palate. Clinical, anthropometric, statistical methods as well as patient photograph analysis and computer technologies were used during the research.Results. Prevalence of congenital asymmetric cleft lip and / or palate was determined (8.59%), classification and novel surgical techniques were offered and the results were evaluated.Conclusions. The prevalence of asymmetric cleft lip and palate is 86 per 1000 newborns with cleft lip and/ or palate. Scientific knowledge about the prevalence of asymmetric cleft lip and palate, as well as the systematization of this type of lesion in classifications, should be present in the practice of a maxillofacial surgeons and rehabilitation physicians who treat patients with this pathology. The proposed surgical techniques for the treatment of asymmetry in bilateral cleftlip and cleft palate provide positive results, excluding the need for further surgery. The reasonable choice of a surgical technique for the treatment of asymmetric cleft lip and palate is individual and may involve the use of additional nanomaterials. The authors’ techniques for the surgical treatment of asymmetric cleft lip and palate can be considered promising and aesthetically justified in view of good cosmetic results and full restoration of functions.

Surgical treatment for utero-vaginal total prolapse

1992 ◽  
Vol 59 (5) ◽  
pp. 26-29
Author(s):  
A. Gastaldi ◽  
G.F. Minini ◽  
C. Paganotti
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Surgical Techniques ◽  
Sexual Problems ◽  
Surgical Operation ◽  
Prolapse Repair ◽  
Positive Results

— The surgical techniques for utero-vaginal total prolapse repair is reported. The aim of surgical operation is to obtain: 1) vaginal dome suspension; 2) cystourethrocele repair; 3) the repair or prevention of an enterocele and a rectocele. The surgical technique reported — adopted in 700 cases — gives positive results whether for the problems of the pelvic static or for functional, urinary or sexual problems.

“I’ve got you under my skin”: borderline states in couple relationships

2020 ◽  
Vol 10 (1) ◽  
pp. 59-71
Author(s):  
Perrine Moran
Keyword(s):  
The Other ◽  
Couple Relationships ◽  
Early Stages ◽  
Popular Songs ◽  
The Relationship

Many couples who come for therapy are struggling with separating from unconscious phantasies and beliefs that enmesh each partner with the other, resulting in states that popular songs powerfully epitomise. While this borderline experience is common and functional in the early stages of being in love its persistence paralyses the development of the relationship. Facing separation from and loss of illusion is a challenge couple therapists are often asked to help with. The argument is illustrated by a case, and by references to some of Cole Porter’s best known songs.

657 Interleukin-6 receptor blockade for management of immune checkpoint inhibitor related adverse events in patients with melanoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A694-A694
Author(s):  
Chantal Saberian ◽  
Faisal Fa’ak ◽  
Jean Tayar ◽  
Maryam Buni ◽  
Sang Kim ◽  
...  
Keyword(s):  
Adverse Events ◽  
Disease Activity ◽  
Median Time ◽  
Interleukin 6 ◽  
Immune Checkpoint ◽  
Activity Index ◽  
Critical Role ◽  
Cancer Center ◽  
Interleukin 6 Receptor ◽  
Md Anderson

BackgroundManagement of certain immune mediated adverse events (irAEs) can be challenging and may require prolonged/chronic immune suppression with corticosteroids or other immunosuppressant which could compromise and even reverse the efficacy of immune checkpoint inhibitors (ICI). While the exact immunobiology of irAEs is not fully understood there is enough evidence that IL-6 induced Th-17 that may play critical role in the pathogenesis. Herein, we describe our clinical experience using interleukin-6 receptor (IL-6R) blockade in management of irAEs in melanoma patients.MethodsWe searched MD Anderson databases to identify cancer patients who had received ICIs between January 2004 and March 2020. Of 11,391 ICI-treated patients, 21 patients with melanoma who received IL-6R blockade after ICI infusion were identified and their medical records were reviewed.ResultsMedian age was 61 years (41–82), 52% were females, 90% received anti-programmed cell death-1 antibodies. Fourteen patients (67%) had de novo onset irAEs (11 had arthritis, and 1 each with polymyalgia rheumatica, oral mucositis, and CNS vasculitis), and 7 patients (33%) had flare of their pre-existing autoimmune diseases (5 had had rheumatoid arthritis, and 1 each with myasthenia gravis and Crohn’s disease). Median time from ICI initiation to irAEs was 91 days (range, 1–496) and to initiation of IL-6R blockade was 6.6 months (range, 0.6–24.3). Median number of IL-6R blockade was 12 (range, 1–35), and 16 patients (76%) were concomitantly receiving corticosteroids of median dose of 10 mg (range, 5–20 mg). Of the 21 patients, irAEs improved in 14 (67%) (95% CI: 46%-87%). Of 13 evaluable patients with arthritis, 11 (85%) achieved remission or minimal disease activity as defined by the clinical disease activity index. Median time from initiation of IL-6R blockade till improvement of irAEs was 2.9 months (range, 1.5–36.9). Nineteen patients tolerated well IL-6R blockade, while two patients stopped treatment due to abdominal pain and sinus tachycardia. The median CRP levels at irAEs was 84 mg/L (0.6–187) and decreased to 1.9 mg/L (0.56–12) at 10 weeks after initiation of IL-6R blockade (P=0.02). Of the 17 evaluable patients, the overall tumor response rate by RECIST-1.1 criteria was similar before and after IL-6R blockade initiation (41% vs. 53%).ConclusionsOur data demonstrated that IL-6R blockade could be an effective therapy for irAEs management without dampening the efficacy of ICIs. Prospective clinical trials with longitudinal blood, tumor, and inflamed tissue biopsies are planned to accurately validate these findings and better study the immunobiology of irAEs.Ethics ApprovalThe study was approved by The University of Texas MD Anderson Cancer Center intuition’s Ethics Board, approval number PA19-0089

scholarly journals Prospective Validation of Indocyanine Green Lymphangiography Staging of Breast Cancer-Related Lymphedema

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1540
Author(s):  
Mads Gustaf Jørgensen ◽  
Navid Mohamadpour Toyserkani ◽  
Frederik Christopher Gulmark Hansen ◽  
Jørn Bo Thomsen ◽  
Jens Ahm Sørensen
Keyword(s):  
Breast Cancer ◽  
Indocyanine Green ◽  
Clinical Severity ◽  
Serious Adverse Events ◽  
Disease Information ◽  
Grading Systems ◽  
Breast Cancer Related Lymphedema ◽  
Disease Stratification ◽  
Md Anderson ◽  
Clinical Measurements

Indocyanine green lymphangiography (ICG-L) allows real-time investigation of lymphatics. Plastic surgeons performing lymphatic reconstruction use the ICG-L for patient selection and stratification using the MD Anderson (MDA) and the Arm Dermal Backflow (ADB) grading systems. However, the applicability of ICG-L in evaluating breast cancer-related lymphedema (BCRL) is sparse and not well established. This study comprehensively examines the usability of ICG-L in the assessment of BCRL. We prospectively performed ICG-L in 237 BCRL patients between January 2019 and February 2020. The aim of this study was to assess the interrater and intrarater agreement and interscale consensus of ratings made using the MDA and ADB scales. Three independent raters performed a total of 2607 ICG-L assessments. The ICG-L stage for each grading system was correlated to the lymphedema volume to assess the agreement between the ICG-L stage and clinical severity. The interrater agreement was near perfect for the MDA scale (kappa 0.82–0.90) and the ADB scale (kappa 0.80–0.91). Similarly, we found a near-perfect intrarater agreement for the MDA scale (kappa 0.84–0.94) and the ADB scale (kappa 0.88–0.89). The agreement between the MDA and the ADB scales was substantial (kappa 0.65–0.68); however, the ADB scale systematically overestimated lower ICG-L stages compared to the MDA scale. The volume of lymphedema correlated slightly with MDA stage (Spearmans rho = 0.44, p < 0.001) and ADB stage (rs = 0.35, p < 0.001). No serious adverse events occurred. The staging of BCRL with ICG-L is reliable, safe, and provides unique disease information unobtainable with clinical measurements alone. The MDA scale seems to provide better disease stratification compared to the ADB scale.

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