The aim of this study was to present a unique case report of myoepithelial carcinoma arising from the external auditory canal and presenting as a huge tympanomastoid mass along with a review of the ...literature.
A 52-year-old woman presented with a large periauricular swelling of a 3-year duration with a recent increase in size over the last 3 months along with pain and bleeding from the mass. The patient was evaluated by clinical examination, haematological and biochemical tests, and computed tomographic and MRI scan of the tympanomastoid region. An incision biopsy was performed before definitive management was initiated.
Computed tomographic scan and MRI were suggestive of a large tympanomastoid mass without any intracranial extension. The incisional biopsy report was suggestive of invasive adenocarcinoma. En-bloc excision of the mass including lateral temporal bone resection along with ipsilateral selective (levels I, II and III) neck dissection was performed under general anaesthesia. The resultant defect was reconstructed by a rotational scalp flap. Immunohistochemistry and histopathology of the excised specimen proved the diagnosis of myoepithelial carcinoma. After surgery, the patient was treated with adjuvant radiotherapy. At 1½ years of follow-up, the patient was doing fine, without any recurrence of disease.
Myoepithelial carcinoma of the ear has rarely been reported in the literature. Histopathology along with immunohistochemistry is the mainstay of diagnosing of this unusual lesion. Meticulous planning and proper execution of optimum surgical excision is the primary treatment modality, which should be supplemented with radiation therapy. Long-term disease-free survival, although rare, can be achieved as in the present case report.
Objective
to investigate long-term survival in patients who underwent pneumonectomy for non-small-cell lung cancer at the University of Kentucky Medical Center.
Methods
we retrospectively reviewed ...100 consecutive pneumonectomy cases from 1998 to 2009 at the University of Kentucky. We were able to obtain follow-up data on 99 of 100 patients.
Results
overall 1-, 2-, and 5-year survival was 66%, 48%, and 32%, respectively. The 1-, 2-, and 5- survival for left pneumonectomy was 76%, 55%, and 40%, respectively, compared to 56%, 44%, and 22%, respectively, for right pneumonectomy. The median survival for left pneumonectomy was 2.4 years compared to 1.2 years for right pneumonectomy (p = 0.056). The 5-year survival for patients diagnosed with stage I disease was 34%, compared to 19% for stage II disease, and 38% for stage III disease. The 5-year survival for patients who underwent neoadjuvant therapy was 31% compared to 39% for patients who received adjuvant therapy and 29% for patients who received surgery alone. These results were also not statistically significant.
Conclusion
neoadjuvant therapy did not adversely affect long-term survival in our study. When compared to left pneumonectomy, right pneumonectomy for non-small-cell lung cancer is associated with adverse postoperative outcomes as well as poorer long-term survival.
Subclinical adrenal insufficiency has been shown to occur in patients with tuberculosis. Whether this insufficiency can be reversed with therapy and on long-term follow up, is not known. We studied ...the effect of antituberculosis treatment (ATT) with respect to reversal of the adrenal insufficiency, as assessed by response to standard dose adrenocorticotropin (ACTH) stimulation test in TB patients.
One hundred and five HIV-negative tuberculosis patients were studied. Of these, 72 patients had pulmonary and 33 had extrapulmonary forms of the disease. Baseline (pre-treatment) standard-dose ACTH stimulation test was done on all the subjects, following which, they were put on standard antituberculosis therapy, depending on the type of disease and were followed up for a period of 30 months. ACTH stimulation tests were performed at follow up, every 6 months.
Baseline (pre-treatment) standard-dose ACTH stimulation test revealed an impaired response in 52 of 105 patients (49.5%). At 6 months, the percentage of responders had increased to 71 per cent with a gradual increasing trend noted thereafter. At 24 months, 31 of the 32 patients (97%) who were followed up demonstrated a normal response to ACTH stimulation. The percentage of responders was comparable in both pulmonary 21 of 22 patients (95%) and extrapulmonary TB 10 of 10 patients (100%) groups at follow up.
Our study shows that nearly half of patients with active tuberculosis had a subclinical adrenal insufficiency indicated by an impaired response to ACTH stimulation test. This insufficiency reverse with therapy in most patients on long-term follow up.
Issues related to applicability of model predictive control (MPC) to the nonlinear and integrating processes are addressed in this study. An industrial four-stage evaporator system is taken as an ...exemplary process, and two different models of this system are used as process and its prediction model in the controller. Unlike the past studies, where the necessity of stabilization is advocated prior to MPC implementation on an open-loop unstable process, nonlinear MPC without any pre-stabilization is successfully achieved by using process state variables for initialization, suitable prediction horizon and sampling period. However, steady state offset was observed. A useful offset removal technique is proposed and implemented successfully. Performance of NMPC is compared with that of decentralized controllers for the evaporator system, and the results show that both can provide comparable control.
The use of oral mucous membrane graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. We investigated the short term result of oral mucous membrane ...graft placed on the ventral surface for management of bulbar urethral stricture. Patients with Bulbar urethral stricture of any length, infection free urinary tract and informed consent for oral mucosa harvesting and urethroplasty were selected for study. We enrolled 108 cases of bulbar urethral stricture patients from January 2004 to July 2009. The mean ± SD preoperative maximum flow rate of 5.2 ± 2.6 ml/sec and mean ± SD PVR 87 ± 58.3 ml were treated by substitution urethroplasty with oral mucous membrane by a single surgical team in a private hospital. Causes of stricture were trauma 26(24.1%), infection 58(53.7%), catheter induced 8(7.4%), post TURP 11(10.2%) and unknown 5(4.6%). Oral mucous membrane was harvested from the cheek or from the inner side of lower lip. Defect of the urethra displayed by longitudinal ventral urethrotomy and the graft was sutured over the edges of the incised urethral mucosa over a 14 Fr latex Foley's catheter. Spongiosum tissue was closed over the graft. Pericatheter urethrogram was performed in all cases to check for the anastomotic leakage and the Catheter was removed after 2 weeks of the procedure. After removal of catheter uroflowmetry & ultrasound scan of bladder were performed to estimate the maximum flow rate and post voidal residue. The patient was followed-up every 3 months with uroflowmetry & ultrasonography. The median (range) age of the patients was 32(21-72) years. Mean follow up period was 36 months (range 12-54). Mean ± SD stricture length was 3.7 ± 2.6 cm. The overall success rate was 91.7%. Mean ± SD flow rate was 23 ± 4.2 ml/sec, mean ± SD post void residue was 25 ± 15.5 ml and patient quality of life (QOL) was excellent in almost all patients. Overall complications were seen in 9(8.3%) cases. Of which, restricture occurred in 6 patients; periurethral fistulae seen in 2 cases and per urethral bleeding in 1 patient. No significant complications were observed at the donor site. Oral numbness and mild discomfort complained by 67.6% patients which were managed by reassurance only. In our experience ventral placement of oral mucous membrane graft along with spongioplasty is a very easy procedure with very encouraging short term result.
Abstract Background Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these ...locations. Methods Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures. Immediate and two-year outcomes were observed. Patient demographics, perioperative details, physician billings, and hospital costs were recorded. Multivariable regression was used to adjust costs by patient and perioperative cost drivers. Results Fifty-one procedures (49%) were performed in the OR and 54 (51%) in the CL. Mean age was 57, and 44% were female. Severe cases were more often performed in the OR (RC ≥ 4; 42% vs. 11%, P < 0.001) and were associated with increased total costs (P < 0.01). OR procedures more often utilized additional stents (stents ≥ 2; 61% vs. 46%, P = 0.214), thrombolysis (12% vs. 0%, P = 0.011), cut-down approach (8% vs. 0%, P = 0.052), and general anesthesia (80% vs. 0%, P < 0.001): these were all associated with increased costs (P < 0.05). After multivariable regression, location was not a predictor of procedure room or total costs but was associated with increased professional fees. Same-stay (5%) and post-discharge reintervention (33%) did not vary by location. Conclusions The OR was associated with increased length of stay, more ICU admissions, and increased total costs. However, OR patients had more severe disease and therefore often required more aggressive intervention. After controlling for these differences, procedure venue per se was not associated with increased costs, but OR cases incurred increased professional fees due to dual-provider charges. Given the similar clinical results between venues, it seems reasonable to perform most stenting in the CL or utilize conscious sedation in the OR.
Flyash has been explored in the laboratory scale experiment as a low cost adsorbent for the removal of methylene blue dye from aqueous solution. The influence of dye concentration, weight of ...adsorbent, stirring rates, influence of temperature, pH on adsorption capacity was studied in batch experimental method. From experimental results it was observed that almost 95-99% of dye colour could be removed from the solution using flyash at different initial conditions. Langmuir, Freundlich and Tempkin isotherm models were used to describe the distribution of dye between the liquid and solid phases in batch studies and it has observed that Langmuir isotherm better represents the phenomenon than Freundlich and Tempkin isotherms. From the experimental results the adsorption rate constant, activation energy, Gibbs free energy, enthalpy and entropy of the reaction were calculated in order to determine the mechanism of the sorption process.
The impact of surgical residents on failure to rescue Kister, Nathaniel L., MD; Ferraris, Victor A., MD, FACS; Martin, Jeremiah T., MB, BCh, FRCSI ...
Journal of the American College of Surgeons,
October 2014, Letnik:
219, Številka:
4
Journal Article
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