42 research outputs found

    Predictors of lymph node involvement in bladder cancer treated with radical cystectomy

    Get PDF
    Objective: To identify the clinical variables associated with prevalence of lymph node metastasis in patients with bladder cancer treated by radical cystectomy and lymphadenectomy for primary bladder cancer. Methods: Review of records of Ninety-five patients who underwent radical cystectomy and pelvic lymph node (LN) dissection during the period of 1995-2008 from a prospectively maintained database. Eighteen patients were excluded due to lack of data on the nodal status, leaving 77 evaluable patients. Associations between LN metastasis and age, gender, duration of disease, number of transurethral resection (TUR) prior to cystectomy, pathological grade and tumour stage was analyzed. Data was analyzed using the SPSS software, version 15. Statistical tests applied were independent sample t test or the Mann Whitney U test, the chi-square test and the Fischer exact test. Results: The median age of the patients was 58 years in lymph node negative group and 63 years in lymph node positive group. There were 87% males and 13% females. LN metastasis was detected in 19 (25%) patients. Mean duration of disease in LN negative patients was 537 +/- 997 days compared to 509 +/- 708 days in LN positive patients. Mean number of TUR were same in both the groups, pathological grade was not found significantly different in both groups, where as primary tumour stage was found to be significantly (p \u3c 0.05) higher in LN positive patients. Conclusions: Higher primary tumour stage at radical cystectomy is associated with higher prevalence of lymph node metastasis

    Chiari Malformation with and without Syringomyelia: Surgical Technique and Outcome in 88 Adult Patients

    Get PDF
    Objective:  This study identified the relationship between posterior fossa craniectomy, expansion neuroplasty, and radiological appearances in patients with Chiari malformation with and without clinical syringomyelia with the surgical outcomes in an attempt to correct the lesion. Materials & Methods:  Eighty-eight patients with Chiari malformation (CM) were included in the study where 70 had associated syringomyelia. All underwent posterior fossa craniotomy, expansion duroplasty without fiddling with cerebellar tonsils. Patients were evaluated at 1 month, 3 months, and 12 months. The MRI studies were done at 12 months when symptomatic relief and radiological findings were evaluated and matched. Results:  Most of the patients were young adults between the age range of 25 – 40 years. The most common complication was pseudomeningocele (5.68%) formation followed by CSF leak (4.54%). Patients with a longer history of Chiari malformation or syrinx-related symptoms and signs had partial relief in symptoms and signs. The poor outcome as expected was seen in patients with atrophic changes in upper limbs and hypertonia in lower limbs, especially in patients with loss of joints position sense and poor balance. Patients showed maximum improvement in headaches both suboccipital as well as generalized. Syringomyelia was decreased in size in 49 patients and remained unchanged in 21.  Dysesthesias were improved in 31 patients. Conclusion:  Clinical improvement was related to the expansion of the posterior fossa and subarachnoid cistern and reduction in the size of the syrinx. Surgical decompression of the posterior fossa should create adequate space for its contents and reduce the syrinx cavity. The relationship between symptomatic improvement and radiological findings is not always linear. Keywords:  Chiari Malformation, Tonsillar Herniation, Syringomyelia, Duroplasty

    Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

    Get PDF
    Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient

    Outcome of Microsurgical Clipping of Ruptured Anterior Circulation Aneurysms

    Get PDF
    Objective: The objective of the study was to analyze the operative outcome of microsurgical clipping in Ruptured Anterior Circulation Aneurysms.Materials and Methods: Twenty patients with Ruptured Anterior Circulation aneurysms were treated with surgical clipping. All the patients were evaluated pre-operatively according to Hunt & Hess and WFNS grading scales. Patients with grade I, II, and III were operated. All the aneurysms were clipped through Pterional approach under General anesthesia and Yasargil Aneurysm clips of appropriate sizes were used in each patient. Outcome was analyzed according to Glasgow Outcome Scale at the end of six months of follow up in each patient.Results: In this series of twenty cases, the mean patient age was 49 years. Lesion location included, the ACA/A. Com 55% (n = 11), the Middle Cerebral artery 25% (n = 5), P. Com 15% (n = 3), Ophthalmic artery 5% (n = 1). Sex distribution, female 55% (n = 11) and male 45% (n = 9). Per-operative complications, rupture of aneurysm 20% (n = 4), and damage to perforating branches of MCA 5% (n = 1). Conclusions: Surgical clipping still is the most efficient treatment of Ruptured Anterior Circulation aneurysm at the beginning of the new millennium. Anterior Communicating Artery is the commonest location of aneurysms. Major determinants of outcome are Hunt & Hess, WFNS grades on admission and the age of the patient

    Incidental renal cell carcinoma in pelvic malignancies

    Get PDF
    Simultaneous diagnosis of renal cell carcinoma with pelvic malignancies is rare but a well-documented phenomenon. It is not uncommon to have incidental renal masses on imaging done for investigating other tumors. There are no established guidelines for the treatment of patients with dual malignancies. The management of such patients is challenging and requires a multidisciplinary approach. We present a series of three cases with a diagnosed pelvic malignancy but further workup revealed a kidney tumor. Both the malignancies were evaluated individually and diagnosed as two different primary neoplastic lesions. This case series examines each distinct patient\u27s presentation, discusses the diagnosis, and compares and contrasts the findings while discussing the literature on this topic

    Patient\u27s outcome of bladder cancer managed by radical cystectomy with lymphadenectomy at a university hospital

    Get PDF
    Objective: To study the impact of tumour staging and nodal metastases in predicting 5- year\u27s survival after radical cystectomy and bilateral pelvic lymphadenectomy for primary bladder cancer. Methods: During the period 1995 to 2005, 58 patients underwent radical cystectomy and bilateral pelvic lymphadenectomy and urinary diversion at a University hospital. Patients were identified using medical indexing coding system (ICD 9CM) using standard key words. The patient records were analyzed and follow up data updated. Disease specific survival, death or recurrence was taken as end point.Results: Out of 58 patients, 50 (86%) were males and 8 (14%) females with a mean age of 61 +/- 13.1 years (range from 27 to 87 years). Of 58 patients, 11 (23%) were excluded from the study because of in adequate follow up. The mean follow up was 5.7 years (range, 7 months to 11 years). The overall 5 years survival was 55% with disease specific survival being 66%. Patients with pathological stage TO at cystectomy have 87% 5 years disease specific survival compared to 60%, in patients with pT4 (p = 0.705). The 5-year survival for node positive patients was 16%, compared to 60% for node negative patients (p \u3c 0.01). Conclusions: Radical cystectomy and bilateral pelvic lymphadenectomy is the standard treatment for muscle invasive and high grade T1 cancers, and as salvage for recurrent cancers. Lymphadenectomy has a potential therapeutic benefit. The pathological stage at cystectomy and nodal status are predictors of 5 years survival

    Inhibitory effect of Polyram DF and Capsicum annum on leaf spot of rose caused by Curvularia lunata in vitro and in planta

    Get PDF
    Rose plants are affected by several diseases caused by fungi, nematode, bacteria, viruses, and other pests. Among all of these, Curvularia lunata causes significant losses to Roses. Present study was focused on In-vitro and In-vivo management of the “Curvularia leaf spot of Rose” caused by Curvularia lunata by using different fungicides and phyto-extracts. Diseased samples were collected from floriculture area of University of Agriculture, Faisalabad for isolation of pathogen. Five fungicides i.e., Cabrio-Top, Curzate-M, Aliette, Polyram-DF and Recado @ (50ppm, 100ppm and 150ppm) and five plant extracts i.e., Allium cepa, Capsicum annuum, Aloe vera, Menthaand Calotropis gigantean with three concentrations @ (5%, 10% and 15%) were evaluated under lab conditions through poisoned food technique by using Complete Randomized Design (CRD), where C. annuum gave best results (9.129mm) followed by Calotropis gigantea (13.003mm), and Polyram-DF was effective (2.218mm) followed by Curzate-M (6.542mm). Best performing fungicides and plant-extracts were subjected to In-vivo management trials. Under green-house conditions, combination of Capsicum annuum + Calotropis gigantean and Polyram-DF + Curzate-M were shown least disease incidence (14.517 and 3.224%). LSD was used for comparing variations between treatments at 5% probability. The results of these experiments were to aid in the evaluation of fungicides and Phyto-extracts, which are the most effective chemicals and phyto-extracts against leaf Spot disease of Rose

    Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

    Get PDF

    Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

    Get PDF
    Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020
    corecore