Inguinal hernias are common, and although the results of surgical repair are often satisfactory, postoperative recovery may be slow, and the hernia may recur. The period of recovery after repair of ...inguinal hernia in patients with paid recovery time is four to six weeks in most Western countries.
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Elimination of anxiety about resuming work could shorten the recovery, but this possibility has not been studied.
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Recurrence rates have ranged from less than 1 percent to more than 10 percent, with a follow-up of more than five years.
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These data should be viewed with some caution, however, because follow-up . . .
Background
Rapid genetic counseling and testing (RGCT) in newly diagnosed high‐risk breast cancer (BC) patients may influence surgical treatment decisions. To successfully integrate RGCT in practice, ...knowledge of professionals’, and patients’ attitudes toward RGCT is essential.
Methods
Between 2008 and 2010, we performed a randomized clinical trial evaluating the impact of RGCT. Attitudes toward and experience with RGCT were assessed in 265 patients (at diagnosis, 6‐ and 12‐month follow‐up) and 29 medical professionals (before and after the recruitment period).
Results
At 6‐month follow‐up, more patients who had been offered RGCT felt they had been actively involved in treatment decision‐making than patients who had been offered usual care (67% vs 48%, P = 0.06). Patients who received DNA‐test results before primary surgery reported more often that RGCT influenced treatment decisions than those who received results afterwards (P < 0.01). Eighty‐seven percent felt that genetic counseling and testing (GCT) should preferably take place between diagnosis and surgery. Most professionals (72%) agreed that RGCT should be routinely offered to eligible patients. Most patients (74%) and professionals (85%) considered surgeons the most appropriate source for referral.
Conclusions
RGCT is viewed as helpful for newly diagnosed high‐risk BC patients in choosing their primary surgery and should be offered routinely by surgeons.
Female breast cancer patients carrying a BRCA1/2 mutation have an increased risk of second primary breast cancer. Rapid genetic counseling and testing (RGCT) before surgery may influence choice of ...primary surgical treatment. In this article, we report on the psychosocial impact of RGCT.
Newly diagnosed breast cancer patients at risk for carrying a BRCA1/2 mutation were randomized to an intervention group (offer of RGCT) or a usual care control group (ratio 2:1). Psychosocial impact and quality of life were assessed with the Impact of Events Scale, Hospital Anxiety and Depression Scale, Cancer Worry Scale, and the EORTC QLQ-C30 and QLQ-BR23. Assessments took place at study entry and at 6- and 12-month follow-up visits.
Between 2008 and 2010, 265 patients were recruited into the study. Completeness of follow-up data was more than 90%. Of the 178 women in the intervention group, 177 had genetic counseling, of whom 71 (40%) had rapid DNA testing and 59 (33%) received test results before surgery. Intention-to-treat and per-protocol analyses showed no statistically significant differences between groups over time in any of the psychosocial outcomes.
In this study, RGCT in newly diagnosed breast cancer patients did not have any measurable adverse psychosocial effects.
Several laparoscopic techniques have been introduced to repair inguinal hernia, the newest and most promising being a totally extraperitoneal approach. Nevertheless, the surgeon may encounter several ...complications and technical difficulties associated with the transition from the conventional anterior operation.
In late 1993 and 1994, 120 patients were operated on for inguinal hernia using the totally extraperitoneal approach by four laparoscopic surgeons inexperienced in this new technique in a secondary referral setting. Their learning curve was assessed through operation time, perioperative and postoperative complications, and technical difficulties.
Median operative time decreased significantly (
P = 0.0003) when going through the learning curve. During the initial part of the learning curve, conversion to another technique was necessary in 10 (8%) cases, and in 6 of these cases, conversion was needed for a peritoneal tear (relative risk for conversion if peritoneal tear was present: 4.0; 95% confidence interval 1.2 to 13.1,
P = 0.025). The median operative time for Nyhus type Illb and IVb hernias was significantly longer than for other types (70 versus 55 minutes,
P = 0.003). Median postoperative stay was 2 days (range 0 to 7). There were 10 recurrences within 6 months due to technical or judgement errors.
For surgeons, the learning curve for totally extraperitoneal laparoscopic hernia repair can be overcome; however, the presence of an experienced surgeon during the procedure is vital, as this may prevent unnecessary recurrences.
The addition of branched chain amino acids (BCAA) to total parenteral nutrition (TPN) solutions of balanced aminoacid composition has been reported to result in improved nitrogen balance, ...preservation of plasma protein levels, and improved immune function; however, only a few large clinical studies have been performed, yielding conflicting results. We, therefore, studied in a prospective, randomized double blind trial, the effects of BCAA enrichment of an otherwise isonitrogenous and isocaloric TPN solution on plasma protein levels in 101 traumatized and septic patients. TPN-derived nitrogen intake was similar in both study groups. Nitrogen balances in the BCAA group (n = 49) were not different from those in the standard group (n = 52). Plasma total protein levels increased significantly in the standard group resulting in a significant difference between study groups on day 7. Pre-albumin levels increased significantly in the BCAA group and in the standard group. The number of neutrophils (rods) was significantly lower in the standard group compared to the BCAA group on day 7. Lymphocytes increased significantly in the standard group as did the number of platelets, resulting in a significant difference between study groups on day 7. We conclude that BCAA enrichment of standard TPN solutions does not result in more efficient nitrogen metabolism in septic or traumatized patients.
An increase in extreme precipitation is projected for many areas worldwide in the coming decades. To assess the impact of increased precipitation intensity on water security, we applied a ...regional-scale hydrological and soil erosion model, forced with regional climate model projections. We specifically considered the impact of climate change on the distribution of water between soil (green water) and surface water (blue water) compartments. We show that an increase in precipitation intensity leads to a redistribution of water within the catchment, where water storage in soil decreases and reservoir inflow increases. This affects plant water stress and the potential of rainfed versus irrigated agriculture, and increases dependency on reservoir storage, which is potentially threatened by increased soil erosion. This study demonstrates the crucial importance of accounting for the fact that increased precipitation intensity leads to water redistribution between green and blue water, increased soil erosion, and reduced water security. Ultimately, this has implications for design of climate change adaptation measures, which should aim to increase the water holding capacity of the soil (green water) and to maintain the storage capacity of reservoirs (blue water), benefiting rainfed and irrigated agriculture.
Summary Background The efficacy of radioembolisation for the treatment of liver tumours depends on the selective distribution of radioactive microspheres to tumorous tissue. The distribution of ...holmium-166 (166 Ho) poly(L-lactic acid) microspheres can be visualised in vivo by both single-photon-emission CT (SPECT) and MRI. In this phase 1 clinical trial, we aimed to assess the safety and the maximum tolerated radiation dose (MTRD) of166 Ho-radioembolisation in patients with liver metastases. Methods Between Nov 30, 2009, and Sept 19, 2011, patients with unresectable, chemorefractory liver metastases were enrolled in the Holmium Embolization Particles for Arterial Radiotherapy (HEPAR) trial. Patients were treated with intra-arterial166 Ho-radioembolisation in cohorts of three patients, with escalating aimed whole-liver absorbed doses of 20, 40, 60, and 80 Gy. Cohorts were extended to a maximum of six patients if dose-limiting toxicity occurred. Patients were assigned a dose in the order of study entry, with dose escalation until dose-limiting toxicity was encountered in at least two patients of a dose cohort. Clinical or laboratory toxicities were scored according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 3.0. The primary endpoint was the MTRD. Analyses were per protocol. This study is registered with ClinicalTrials.gov , number NCT01031784. Findings 15 patients underwent166 Ho-radioembolisation at doses of 20 Gy (n=6), 40 Gy (n=3), 60 Gy (n=3), and 80 Gy (n=3). Mean estimated whole-liver absorbed doses were 18 Gy (SD 2) for the 20 Gy cohort, 35 Gy (SD 1) for the 40 Gy cohort, 58 Gy (SD 3) for the 60 Gy cohort, and 73 Gy (SD 4) for the 80 Gy cohort. The 20 Gy cohort was extended to six patients because of the occurrence of dose-limiting toxicity in one patient (pulmonary embolism). In the 80 Gy cohort, dose-limiting toxicity occurred in two patients: grade 4 thrombocytopenia, grade 3 leucopenia, and grade 3 hypoalbuminaemia in one patient, and grade 3 abdominal pain in another patient. The MTRD was identified as 60 Gy. The most frequently encountered laboratory toxicities (including grade 1) were lymphocytopenia, hypoalbuminaemia, raised alkaline phosphatase, raised aspartate aminotransferase, and raised gamma-glutamyltransferase, which were all noted in 12 of 15 patients. Stable disease or partial response regarding target lesions was achieved in 14 of 15 patients (93%, 95% CI 70–99) at 6 weeks and nine of 14 patients (64%, 95% CI 39–84) at 12 weeks after radioembolisation. Compared with baseline, the average global health status and quality of life scale score at 6 weeks after treatment had decreased by 13 points (p=0·053) and by 14 points at 12 weeks (p=0·048). In all patients, technetium-99m (99m Tc)-macro-aggregated albumin SPECT,166 Ho scout dose SPECT, and166 Ho treatment dose SPECT showed similar patterns of the presence or absence of extrahepatic deposition of activity. Interpretation166 Ho-radioembolisation is feasible and safe for the treatment of patients with unresectable and chemorefractory liver metastases and enables image-guided treatment. Clinical166 Ho-radioembolisation should be done with an aimed whole-liver absorbed dose of 60 Gy. Funding Dutch Cancer Society, Dutch Technology Foundation STW.
Plasma-amino acid profiles in sepsis and stress VENTE, J. P; VON MEYENFELDT, M. F; VAN EIJK, H. M. H ...
Annals of surgery,
1989, 1989-Jan, 1989-01-00, 19890101, Letnik:
209, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Sepsis has been associated with specific plasma amino acid patterns. Sixty-five patients were prospectively investigated as to whether these patterns are indeed sepsis specific, or specific for ...metabolic stress without concomitant sepsis, or associated with the presence of organ failure. Virtually all aminoacid levels were decreased by 10-30% (p less than 0.05), whereas cystine and phenylalanine were significantly elevated. These changes were more pronounced in severe sepsis. Organ failure was not associated with significantly altered amino acid profiles. No differences were found between sepsis and stress without signs of sepsis. In addition, imminent death was not associated with aberrant amino acid profiles. We conclude that sepsis and metabolic stress are associated with changes in plasma amino acid profiles, but that such changes are aspecific and therefore poor indicators of disease severity.
The parameterization of crop coefficients (kc) is critical for determining a water balance. We used satellite-based and literature-based methods to derive kc values for a distributed hydrologic ...model. We evaluated the impact of different kc parametrization methods on the water balance and simulated hydrologic response at the basin and sub-basin scale. The hydrological model SPHY was calibrated and validated for a period of 15 years for the upper Segura basin (~2500 km2) in Spain, which is characterized by a wide range of terrain, soil, and ecosystem conditions. The model was then applied, using six kc parameterization methods, to determine their spatial and temporal impacts on actual evapotranspiration, streamflow, and soil moisture. The parameterization methods used include: (i) Normalized Difference Vegetation Index (NDVI) observations from MODIS; (ii) seasonally-averaged NDVI patterns, cell-based and landuse-based; and (iii) literature-based tabular values per land use type. The analysis shows that the influence of different kc parametrization methods on basin-level streamflow is relatively small and constant throughout the year, but it has a bigger effect on seasonal evapotranspiration and soil moisture. In the autumn especially, deviations can go up to about 15% of monthly streamflow. At smaller, sub-basin scale, deviations from the NDVI-based reference run can be more than 30%. Overall, the study shows that modeling of future hydrological changes can be improved by using remote sensing information for the parameterization of crop coefficients.
A method is presented for determination of the enantiomeric composition of hydroxyperoxides formed by enzymic oxygenation of unsaturated fatty acids. After reduction of the hydroperoxy group with ...NaBH4, and esterification, the positional isomers of the resulting hydroxy compounds are separated by high performance liquid chromatography. The latter are subsequently subjected to a chiral derivatization to form diastereomeric alpha-methoxy-alpha-trifluoromethylphenylacetate esters. Determination of the diastereomeric composition by a NMR shift experiment furnishes the enantiomeric composition of the parent hydroperoxides. The method has been applied to the hydroperoxides formed by incubation of linoleic acid by corn germ or soybean lipoxygenase. Our results indicate that under the conditions used the hydroperoxides are mainly enantiospecifically formed.
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