bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Assessment for Severe Postoperative Hypocalcaemia after Neck Exploration for Primary Hyperparathyroidism
Authors: Kald B. A. , Heath D. I. , Lausen I. , Mollerup C. L. 
Published: January 2017

Background and Aims: A further development of the risk profile for severe postoperative hypocalcaemia after surgery for primary hyperparathyroidism (pHPT) was made with the aim of expanding the group of patients who can be discharged safely after 23 hours. Methods: Prospective study with 156 consecutive pHPT patients (158 operations) during 2001 and 2002. Risk factors for postoperative severe hypocalcaemia (ionised calcium <1 mmol/L), were (1) preoperative concentration of parathyroid hormone (PTH) > 35 pmol/L (five times the upper reference value, reference range 1.1 to 6.9), (2) history of previous neck surgery, (3) biopsy/excision of > 2 parathyroid glands or (4) concomitant thyroid surgery. Results: The risk factors showed a sensitivity of 100 % (9/9). In 110 of the operations (70%) no risk factors were identified. Postoperative calcium levels were significantly lower after 48 operations with risk factor(s) identified, as compared to the group without risk factors (p < 0.01). Seven of 17 patients (41%) with PTH > 35 pmol/L developed severe postoperative hypocalcaemia. Two of 31 patients (6%) with PTH < 35 pmol/L in the presence of other risk factor(s) developed severe postoperative hypocalcaemia. Conclusion: Patients with no risk factor can safely been discharged from hospital on the first postoperative day. Patients with preoperative concentration of PTH > 35 pmol/L (five times the upper reference value) should stay in hospital until nadir level of calcium is reached. Patients with concentration of parathyroid hormone less than 35 pmol/L in the presence of other risk factor(s) may have an early discharge from hospital (second postoperative day) combined with outpatient measurements of calcium levels.
Volume versus Outcome When Treating Abdominal Aortic Aneurysm Electively — Is There Evidence to Centralise?
Authors: Troëng T. 
Published: January 2017

Aim: To identify evidence for the minimum annual case load of open repairs of abdominal aortic aneurysms compatible with an acceptable perioperative mortality rate. Method: A PubMed search resulted in 137 references, sixteen articles with original data on volume and mortality not older than ten years were identified and selected for review Result: Three studies found no volume-mortality relationship when controlled for age, sex and medical risk. Six studies verified volume thresholds of 20 procedures per year or more. In seven studies hospital volumes of 7–17 elective abdominal aortic aneurysm (AAA) repairs per year were sufficient to reach a mortality rate of a national average or similar to that of higher volume centres. No studies were published on the minimum annual case-load of EndoVascular Aneurysm Repair (EVA R), or of a combination of EVAR and open repair. Conclusion: Recent studies in North America and in Europe indicate that 10–15 procedures annually can be sufficient to safely perform open AAA repairs. Centres regularly performing less should consider referral. Continuous monitoring and audit of risk-adjusted perioperative mortality rates should be practiced in all centres.
Adoption of Single Incision Laparoscopic Cholecystectomy in Small-Volume Hospitals: Initial Experiences of 51 Consecutive Procedures
Authors: Lill S. , Karvonen J. , Hämäläinen M. , Falenius V. , Rantala A. , Grönroos J. M. , Ovaska J. 
Published: January 2017

Background and Aims: Laparoscopic cholecystectomy (LC) via three or four ports has been the standard operation for gallstone disease. Recently, the development of multichannel port devices has allowed LCs to be performed through a single fascial incision in the umbilicus. Here, we report our experiences of the adoption of the single incision laparoscopic cholecystectomy (SILC) in two small-volume community hospitals. Material and Methods: From January until July 2010, 51 consecutive patients (41 females and 10 males, the mean age 44 (21–75) years, BMI 26 (18–35)) underwent elective SILC for symptomatic gallstone disease in Salo (n = 29) and Loimaa (n = 22) hospitals. Results: Of the 51 operations, 42 (82%) were accomplished without additional troacars. Seven (14%) procedures were converted to multiple-port technique and two (4%) to open cholecystectomy. In 25 (49%) operations, transabdominal retraction sutures through the gallbladder were used to maintain a good view of the triangle of Calot. The mean operative time was 74 (31–155) min. No major intraoperative complications occurred. The mean hospital stay was 0.6 (0–3) days. During a mean follow up of 4 (1–7) months, five (10%) patients had wound infection, and one (2%) had hematoma and prolonged pain in the insertion site of the retraction suture. One (2%) patient was reoperated for continuous pain in umbilical wound without findings at operation but with good results. One (2%) patient had subphrenic abscess seven months postoperatively. Conclusions: Our initial experiences indicate that SILC can be adopted without major complications in small-volume hospitals but the rate of wound infections seems to increase with the introduction of SILC.
Risk Factors for Conversion during Laparoscopic Cholecystectomy — Experiences from a General Teaching Hospital
Authors: van der Steeg H. J. J. , Alexander S. , Houterman S. , Slooter G. D. , Roumen R. M. H. 
Published: January 2017

Background and Aims: Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic cholelithiasis. Conversion, however, is sometimes necessary. The aim of this study was to determine predictive factors of conversion in patients undergoing LC for various indications in elective and acute settings in a general teaching hospital. Material and Methods: A retrospective analysis was performed on 972 consecutive patients who underwent a laparoscopic cholecystectomy in Máxima Medical Centre in Veldhoven, the Netherlands, from January 2000 till January 2006. Recorded data were sex, age, indication for LC, conversion to open cholecystectomy, reason for conversion, performing surgeon, co-morbidity, type of complication, length of hospital stay and 30-day mortality. Results: Conversion to open cholecystectomy was performed in 121 patients (12%). The most frequent reasons for conversion were infiltration/fibrosis of Calot's triangle (30%) and adhesions (27%). In the multivariate analyses male gender (OR 1.67, 95% CI 1.07–2.59), age > 65 years (OR 2.10, 95% CI 1.32–3.34), acute cholecystitis (OR 11.8, 95% CI 6.98–20.1), recent acute cholecystitis (OR 4.71, 95% CI 2.42–9.18) and recent obstructive jaundice (OR 20.6, 95% CI 4.52–94.1) were independent predictive factors for conversion. Conclusions: Male gender, age > 65 years, (recent) acute cholecystitis and recent obstructive jaundice are independent predictive risk factors for conversion. By appreciating these risk factors for conversion, preoperative patient counselling can be improved.
Clinical Implications of the Histologically and Immunohistochemically Detected Solitary Lymph Node Metastases in Gastric Cancer
Authors: Griniatsos J. , Yiannakopoulou E. , Gakiopoulou H. , Alexandrou A. , Dimitriou N. , Karavokyros I. , Felekouras E. 
Published: January 2017

Background: Topographic correlation between the primary gastric tumor and the first peri- and extragastric lymphatic drain basin (solitary lymph node metastasis) on gastrectomy specimens, represents a reliable method to investigate and understand the exact pattern of lymphatic drainage from a gastric tumor. Analyzing that correlation, useful information regarding the extent of the appropriate oncological perigastric lymphadenectomy will be provided. We retrospectively evaluate the usefulness of a modified D2 lymphadenectomy in gastric cancer patients, based on the topographic correlation between the primary tumor and the location of the solitary lymph node metastases, as they were detected by histology and immunohistochemistry. Materials and Method: Between April 2003 and March 2010, 134 gastric cancer patients were submitted to a modified D2 lymphadenectomy. Postoperatively, the standard histological examination by hematoxylin and eosin (HE) staining, disclosed metastatic infiltration of at least two lymph nodes in 90 patients, solitary lymph node metastases were histologically detected in 10 patients, while the remaining 34 patients were classified as pN0. All lymph nodes of the ten patients with histological solitary lymph node metastases, as well as the 34 patients who had been classified as pN0 by histology, were further submitted to immunohistochemistry for micrometastases detection. More than one micrometastases were detected in none of them, while in seven patients solitary micrometastases were detected either in the level I perigastric or in the level II extragastric lymph nodes stations (skip micrometastases). Results: Solitary lymph node metastases were detected by histology in ten patients and by immunohistochemistry in additional seven (nine females and eight males). Solitary metastases were detected in the level I LN stations in seven patients (four by histology and three by immunohistochemistry) and in the level II LN stations in ten patients (six by histology and four by immunohistochemistry). In order of frequency, the solitary lymph node metastases were located in the no 7 (n = 6), no 6 (n = 4), no 9 (n = 2), no 5 (n = 2), no 4 (n = 1), no 8 (n = 1) and no 12 (n = 1) LN stations. Skip metastases encountered the 60% of the histologically detected, 57% of the immunohistochemically detected and 59% of all solitary lymph node metastases. 80% of solitary metastases in the level II LN stations, were mainly located in the nos 7–9 lymph node stations complex. Tumors of the lower and middle-third of the stomach were equally drained both to the level I and level II lymph node stations, while 67% of the tumors towards the lesser curvature, were mainly drained in the level II lymph node stations. Conclusion: D2 lymphadenectomy increases the number of true R0 resections. Thus, a modified D2 lymphadenectomy should be routinely performed in gastric cancer patients.
Translation and Validation of the Norwegian Version of the Fecal Incontinence Quality-Of-Life Scale
Authors: Dehli T. , Martinussen M. , Mevik K. , Stordahl A. , Sahlin Y. , Lindsetmo R. O. , Vonen B. 
Published: January 2017

Background and Aim: Fecal incontinence quality-of-life scale (FIQLS) is a condition-specific health-related quality-of-life questionnaire composed of four scales: lifestyle, coping/behaviour, depression/self-perception and embarrassment. It has been widely translated and used as an evaluation tool for patients with fecal incontinence. Our aim was to translate the FIQLS, and to test some of the psychometric properties of the Norwegian version of the questionnaire. Material and Methods: The FIQLS was translated to Norwegian, and administered to a sample of 76 patients (73 women) who completed the questionnaire at baseline and again after three weeks. In addition, the severity of incontinence was assessed by phone-interviews (St. Mark's score). Results: Three of four domains had good internal consistency in terms of Cronbach's alpha (.83–.91), the fourth (embarrassment) somewhat lower (.64). Stability over time was acceptable for all domains with ICC ranging from .74 to .86. Correlation with severity of incontinence (St. Mark's score) was medium to large for all four domains (–.46 to –.63) supporting the construct validity of the Norwegian FIQLS. Conclusion: The Norwegian version of fecal incontinence quality-of-life scale has been successfully translated and tested.
Consulting the “Experts”: A Pilot Study on Perceptions of Professional Support among Lung Transplant Recipients and Accompanying Relatives
Authors: Ullrich Gerald , Jänsch Heyka , Schmidt Sandra , Strüber Martin , Niedermeyer Jost 
Published: January 2017

Background Lung transplantation is extremely stressful for patients and accompanying support persons. Purpose To improve delivery of care, we designed a cross-sectional study about unmet needs and perceived helpfulness of staff. Methods The sample consisted of 30 adult lung transplant recipients with cystic fibrosis (and 22 relatives) and 20 age-matched recipients with other reasons for transplantation (and 17 relatives). Mean survival since transplantation was 5 years. Data were collected via questionnaires (numerical rating scales and fill-in-the-blank items). Results Most patients in both groups were satisfied with staff support (nurse, doctor) especially during the acute stage of illness. Relatives were less satisfied at all stages. Patients' satisfaction with doctors' support was higher after than before transplantation, but the opposite was true for relatives. Insufficient continuity of care was the most frequent critical comment from patients and support persons. Recommendations to improve delivery of care included providing access to psychosocial professionals and broadening the information provided before transplantation. Conclusions Regular screening of customer satisfaction should become routine. Particular attention should be paid to support persons.
Indo-Canadian Beliefs regarding Organ Donation
Authors: Molzahn Anita E. , Starzomski Rosalie , McDonald Michael , O'Loughlin Chloe 
Published: January 2017

Context There is concern that a disproportionately high number of people of South Asian origin await transplantation in Canada. The donation rate is low in this population, and it is difficult to obtain good tissue matches. Objective To explore the values and beliefs regarding organ donation among Indo-Canadian people living in British Columbia. Design A naturalistic qualitative study was designed. Individual interviews and focus groups were held to collect data pertaining to beliefs regarding organ donation. Setting Lower Mainland of British Columbia, Canada. Participants A total of 40 Indo-Canadian persons participated; a wide range of ages, religions, and backgrounds were represented. Results The major themes that emerged from the data related to context (including family/community, religion, trust in the healthcare system, and knowledge about organ donation); and values and beliefs (including intergenerational considerations, death and dying, and the organ donation process). Participants noted that people from their community were reluctant to discuss death and related issues such as organ donation. Although there was recognition of the importance of individual decision making pertaining to organ donation, the participants believed that family and community members also should be involved. Conclusions Beliefs varied considerably among participants, and one should not make assumptions about the beliefs of any one individual based primarily on that individual's membership in an ethnocultural community.
Role of “Relatedness” in Donation Discussions with Next of Kin: An Empirical Study of the Common Wisdom
Authors: Dodd-McCue Diane , Tartaglia Alexander 
Published: January 2017

Context Demographic similarities between support personnel and next of kin are of increasing interest. Studies examining like-race requestors have not produced clear and consistent outcomes. No studies have examined demographic relatedness factors for family support personnel who are not requestors. Objectives To examine the degree of “relatedness” between family communication coordinator chaplains and next of kin in cases that resulted in consent for donation. To examine “relatedness” in terms of demographic characteristics between primary hospital family support individuals and next of kin. Design Retrospective nonexperimental descriptive design spanning 1997 to 2004. Main Outcome Measures Demographic characteristics including gender, race and ethnicity, age, religion, and contact time. Results The results fail to support the hypothesis that the degree of “relatedness” between the family communicator and next of kin is associated with positive consent decisions. The findings show that gender is a shared quality in 60% of these cases, and race, age, and religion are even more infrequently shared qualities. The findings also suggest an elevated role of women in the donation discussion. Conclusions This study fills the void of empirical research through its use of objective outcome measures. The results fail to support the common wisdom and bring to question the foundation of many programs used to promote organ donation. Additionally, the findings emphasize the need for more rigorous investigations and development of more refined, valid measures for examining factors that may influence the donation discussion.
Living Donation Decision Making: Recipients' Concerns and Educational Needs
Authors: Waterman Amy D. , Stanley Sara L. , Covelli Tonie , Hazel Erik , Hong Barry A. , Brennan Daniel C. 
Published: January 2017

Context Despite the advantages of living donor transplantation, evidence suggests that some potential recipients with living donors have psychological concerns that prevent them from pursuing living donation. Addressing these concerns through education may increase the rates of living donation. Objective To understand the psychological barriers and educational needs of potential kidney recipients regarding living donation. Subjects and Design Qualitative focus group study of kidney transplant recipients, donors, and family members to explore their assessment of the advantages of dialysis and deceased donor transplantation over living donation, their concerns about living donation, and what types of living donation education would be most helpful. Results Kidney recipients reported that they might not pursue living donation because they felt guilty and indebted to the donor, did not want to harm or inconvenience the donor, did not want to accept a kidney that a family member might need later, and did not want to disappoint the donor if the kidney failed. Recipients were generally unaware that donors could personally benefit from donating and would rather wait for donor volunteers than ask anyone directly. Both donors and recipients thought that training on how to make the donation request and education about living donors' motivations for donation and transplant experience could help more renal patients pursue living donation.
Unruptured Aneurysm: Vasospasm after Surgery and Endovascular Treatment
Authors: Gutiérrez O. , Caldas J.G.M.P. , Rabello J.P. 
Published: January 2017

Arterial cerebral vasospasm in different pathological conditions other than subarachnoid haemorrhage (SAH) caused by ruptured aneurysm is uncommon. The haemodynamics-clinical consequences of such conditions makes a quick diagnosis, vital to choose the best therapeutic strategy. A 55-year-old woman presented chronic headache. Computed tomography scan revealed an image suggesting carotid aneurysm on the left which was confirmed by digital angiography in the ophthalmic segment. Programmed surgery of clipping aneurysm was carried out without complications. The patient remained without morbidity for the first 16 hours, then she developed progressive aphasia, right motor deficit and loss of consciousness. The angiography showed severe vasospasm in horizontal segments of anterior cerebral artery (A1) and middle cerebral artery (M1). Vasodilatation with topic papaverine by selective microcatheterism in A1 and M1 segments achieved clinical-radiological success in time. The patient was discharged on the seventh day, with Glasgow Coma Scale (GCS) 15/15 and slight right hemiparesis. Vasospasm pathogenesis in conditions other than SAH from ruptured aneurysm remains a scientific frontier for ongoing research. We know about the short half-life effect of papaverine and believe that the success in this particular case was accurate and definite due to the fact that the mechanism of the spasm presented no bleeding in the subarachnoid cisterns.
The Development for Polymer Actuator Active Catheter System
Authors: Sewa S. , Onishi K. , Oguro K. , Asaka K. , Taki W. , Toma N. 
Published: January 2017

Electric stimuli polymer-metal composite actuator material has been developed for active catheter system and other widely new applications. The polymer actuator is made of ion exchange polymer and gold as electrode, and a pulse voltage of 3 volts on the actuator gave a quick bend 90 degree angle. This composite material is possible to make small size, light and soft actuator. So now we can actually develop an active catheter for the interventional radiology surgery. The prototype polymer actuator active catheter has been developed by using polymer actuator technology and Micro Electronics Mechanical System (MEMS) technologies. The active catheter is controllable from the outside of the body by electric signal. The tip part of the catheter is made of the polymer actuator tube and bends 90 degree angles. The animal tests (dog) showed good actuator performance to control right direction and bending angle at bifurcation of blood vessel and aneurysms.
Carotid Artery Stenting: Experience of a Single Institute in China
Authors: Li S. M. , Li D. , Ling F. , Miao Z. R. , Wang M. L. 
Published: January 2017

Concern regarding the safety of Carotid angioplasty and stenting (CAS) exists because of the risk of cerebral embolization during the procedure. The purpose of this article is to discuss that technology modification may improve the outcomes of this procedure. Between October 1997 and October 2004, 439 consecutive patients with 478 stenotic carotid arteries were treated. 284 vessels were stented without the use of embolic protection devices and 194 vessels with protection. Among cases not using protection device, 201 arteries were stented with predilation alone, 63 with postdilation alone, six with both pre- and post-dilation, two with neither and twelve were stented with balloon expandable stents. The technical success of 100%. The combined stroke and death rate during the procedure and the 30-day follow-up at 30 days was 1.67% overall. Three (0.63%) deaths occurred; one was due to a major infarction secondary to stent breakage, and two died of massive reperfusion intracerebral haemorrhage. There were total six ischemic stroke, of the five ischemic strokes wich developed in nonprotection group, two were among 201 cases with predilation alone (0.99%), which developed after stent deployment and postprocedure, and three among 63 cases with postdilation alone (4.76%), which developed immediately after postdilation. The incidence of ischemic stroke was lower among those who were stented with predilation alone than among those who were stented with postdilation alone. This likely results from reduced intimal injury and decreased risk of embolic complications
Retrospective Study of Complications Arising during Cerebral and Spinal Diagnostic Angiography from 1998 to 2003
Authors: Leonardi M. , Cenni P. , Simonetti L. , Raffi L. , Battaglia S. 
Published: January 2017

This retrospective study aimed to assess the percentage of complications in the daily practice of cerebral and spinal cord diagnostic angiography at our institution and to compare this with literature reports published in the last twenty years and guidelines for angiography. From 1st December 1998 to 1st December 2003 2154 patients underwent digital angiography for a total of 5996 vessels selected. Three neurological complications arose during angiographic procedures in the five year period. Focal neurological deficit resolving within 24h in two patients, Permanent neurological deficit in one patient. There were no adverse systemic reactions to contrast medium. Retrospective analysis of our cohort disclosed a complication rate of 0.1% for transient neurological complications and 0.05% for permanent deficits.