Journal articles: 'University of California, Los Angeles. Dept. of Surgery' – Grafiati (2024)

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Born on 1962 at Kamaladi, Kathmandu, Prof Ishwar Lohani completed School Leaving Certificate from St. Xavier’s School. Lalitpur. followed by Senior Cambridge ‘O’ Level from Cambridge University 1980 and Proficiency Certificate Level from Amrit Science Campus. 1984. He did B. Muse. (Sangeet Prabhakar) in Tabala from Kalanidhi Sangit Manavidyalaya under Prayag Sangit Samiti, Allahabad. 1983. He completed M.B.B.S Degree from Madurai Medical College under Madurai Kamaraj University, Madurai, Tamilnadu, India. 1991 and MS General Surgery from PGIMER, Chandigarh, India. 1994. After completion of M.Ch. Plastic Surgery from PGIMER, Chandigarh, India in 1997, he worked initially as a Senior Medical Officer for few months and later as Senior Resident in the Dept. of Surgery, Chandigarh Medical College. He completed fellowship in Plastic Surgery as PSEF International fellow from University of Southern California, Los Angeles and California Pacific Medical Center, San Francisco May 2001 to Feb 2002 under Dr. Randy Sherman and Dr. Bryant Toth. He later did fellowship in Plastic Surgery through the Scottish Foundation for Surgery in Nepal at St. John’s Hospital, Livingstone and Canniesburn Hospital Glasgow, England from Jan 17, 2003 to Feb 28, 2003 under Dr. Auf Quaba and Dr. David Soutar. Presently working as Professor and Head of Department, Dept. of Plastic Surgery and Burns at the T.U. Teaching Hospital, Maharajgunj, Kathmandu, Nepal. He has been involved in the training of MBBS, MS (General Surgery) and MCh Plastic surgery graduates at the Maharajgung Medical Campus. He served as the President of the International College of Surgeons (ICS) Nepal Section; General Secretary of Association of Plastic Surgeons of Nepal (APSON). He has been member of Society of Surgeons of Nepal since 1996 and has contributed a lot in the activities of the society. He has presented in numerous National and International conferences and has numerous publications in international and national journals as well. He served as the Chief Editor of the Journal of Society of Surgeons of Nepal 2008 – 2014.

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

✓ The Los Angeles County General Hospital has played an integral role in the development of medicine and neurosurgery in Southern California. From its fledgling beginnings, the University of Southern California School of Medicine has been closely affiliated with the hospital, providing the predominant source of clinicians to care for and to utilize as a teaching resource the immense and varied patient population it serves.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Since the development of the WHO Safe Surgery Saves Lives initiative and Surgical Safety Checklist, numerous hospitals across the globe have adopted the use of a surgical checklist. The UCLA Health System developed its first extended Surgical Safety Checklist in 2008. Authors of the present paper describe how the time-out checklist used before skin incision was implemented and how it progressed to its current form. Compliance with the most recent version of the checklist has been closely monitored via documentation and observance audits. In addition, the surgical team's appreciation of the current time-out has been assessed. Cultural, practice, and human resource challenges are discussed, as are potential future avenues for innovations in the emerging field of the surgical checklist in neurosurgery.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

I am writing to provide further information in response to inquiries about my recent article on performance issues in Gorecki's music (Tempo 211). The symposium I referred to, at which the composer was present, was titled ‘The Gorecki Phenomenon’, and, in addition to my own, included presentations by Adrian Thomas, Luke Howard, David Kopplin, Mark Swed, and Maria Anna Harley, who organized and chaired the event (and translated the commentaries of Mr Gorecki, who had much to say). This session, along with entire ‘Gorecki Autumn’ at the University of Southern California, was organized to celebrate the endowement of the Directorship of the Polish Music Reference Center by Dr Stefan and Mrs Wanda Wilk, founders of this important resource on Polish music in North America (the website can be consulted at http://www.usc.edu/dept/polishmusic/). A book collecting the research presented at this symposium, along with the lectures and interviews given by the composer during his time in Los Angeles, is forthcoming, edited by Ms Harley.

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Object Low income, government insurance, and minority status are associated with delayed treatment for neurosurgery patients. Less is known about the influence of referral location and how socioeconomic factors and referral patterns evolve over time. For pediatric epilepsy surgery patients at the University of California, Los Angeles (UCLA), this study determined how referral location and sociodemographic features have evolved over 25 years. Methods Children undergoing epilepsy neurosurgery at UCLA (453 patients) were classified by location of residence and compared with clinical epilepsy and sociodemographic factors. Results From 1986 to 2010, referrals from Southern California increased (+33%) and referrals from outside of California decreased (−19%). Over the same period, the number of patients with preferred provider organization (PPO) and health maintenance organization (HMO) insurance increased (+148% and +69%, respectively) and indemnity insurance decreased (−96%). Likewise, the number of Hispanics (+117%) and Asians (100%) increased and Caucasians/whites decreased (−24%). The number of insurance companies decreased from 52 carriers per 100 surgical patients in 1986–1990 to 19 per 100 in 2006–2010. Patients living in the Eastern US had a younger age at surgery (−46%), shorter intervals from seizure onset to referral for evaluation (−28%) and from presurgical evaluation to surgery (−61%) compared with patients from Southern California. The interval from seizure onset to evaluation was shorter (−33%) for patients from Los Angeles County compared with those living in non-California Western US states. Conclusions Referral locations evolved over 25 years at UCLA, with more cases coming from local regions; the percentage of minority patients also increased. The interval from seizures onset to surgery was shortest for patients living farthest from UCLA but still within the US. Geographic location and race/ethnicity was not associated with differences in becoming seizure free after epilepsy surgery in children.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Purpose This open-label, prospective, multicenter single-arm phase II study combined bevacizumab (BV) with radiation therapy (RT) and temozolomide (TMZ) for the treatment of newly diagnosed glioblastoma (GBM). The objectives were to determine the efficacy of this treatment combination and the associated toxicity. Patients and Methods Seventy patients with newly diagnosed GBM were enrolled between August 2006 and November 2008. Patients received standard RT starting within 3 to 6 weeks after surgery with concurrent administration of daily TMZ and biweekly BV. After completion of RT, patients resumed TMZ for 5 days every 4 weeks and continued biweekly BV. MGMT promoter methylation was assessed on patient tumor tissue. A University of California, Los Angeles/Kaiser Permanente Los Angeles (KPLA) control cohort of newly diagnosed patients treated with first-line RT and TMZ who had mostly received BV at recurrence was derived for comparison. Results The overall survival (OS) and progression-free survival (PFS) were 19.6 and 13.6 months, respectively, compared to 21.1 and 7.6 months in the University of California, Los Angeles/KPLA control cohort, and 14.6 and 6.9 months in the European Organisation for Research and Treatment of Cancer-National Cancer Institute of Canada cohort. Correlation of MGMT promoter methylation and improved OS and PFS was retained in the study group. Comparative subset analysis showed that poor prognosis patients (recursive partitioning analysis class V/VI) may derive an early benefit from the use of first-line BV. Toxicity attributable to RT/TMZ was similar, and additional toxicities were consistent with those reported in other BV trials. Conclusion Patients treated with BV and TMZ during and after RT showed improved PFS without improved OS compared to the University of California, Los Angeles/KPLA control group. Additional studies are warranted to determine if BV administered first-line improves survival compared to BV at recurrence.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

IntroductionAbout 42 million surgeries are performed annually in the USA. While the postoperative mortality is less than 2%, 12% of all patients in the high-risk surgery group account for 80% of postoperative deaths. New onset of haemodynamic instability is common in surgical patients and its delayed treatment leads to increased morbidity and mortality. The goal of this proposal is to develop, validate and test real-time intraoperative risk prediction tools based on clinical data and high-fidelity physiological waveforms to predict haemodynamic instability during surgery.Methods and analysisWe will initiate our work using an existing annotated intraoperative database from the University of California Irvine, including clinical and high-fidelity waveform data. These data will be used for the training and development of the machine learning model (Carnegie Mellon University) that will then be tested on prospectively collected database (University of California Los Angeles). Simultaneously, we will use existing knowledge of haemodynamic instability patterns derived from our intensive care unit cohorts, medical information mart for intensive care II data, University of California Irvine data and animal studies to create smart alarms and graphical user interface for a clinical decision support. Using machine learning, we will extract a core dataset, which characterises the signatures of normal intraoperative variability, various haemodynamic instability aetiologies and variable responses to resuscitation. We will then employ clinician-driven iterative design to create a clinical decision support user interface, and evaluate its effect in simulated high-risk surgeries.Ethics and disseminationWe will publish the results in a peer-reviewed publication and will present this work at professional conferences for the anaesthesiology and computer science communities. Patient-level data will be made available within 6 months after publication of the primary manuscript. The study has been approved by University of California, Los Angeles Institutional review board. (IRB #19–0 00 354).

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

14532 Background: Significant advances in the diagnosis, staging, and treatment of patients with renal cell carcinoma (RCC) during the last 2 decades have resulted in improved survival of a select group of patients and an overall change in the natural history of the disease. We describe the pathologic characteristics and long-term survival in patients treated for localized and metastatic RCC at a single tertiary care institution. Methods: Between 1990 and 2005, 1431 patients diagnosed with a renal mass underwent surgical resection and were evaluated for differences in clinicopathologic characteristics and survival based on the University of California-Los Angeles Integrated Staging System (UISS). Data were analyzed using standard statistical methods. Results: Following surgical resection, RCC was found in 1269 patients at pathologic evaluation. Of these patients, 473 had evidence of metastatic dissemination at time of surgery. The primary tumor in patients with metastatic disease was more likely to be clear cell (78.8% vs. 72.9%, p = 0.02), collecting duct (1.3% vs. 0.1%, p = 0.01), or undifferentiated (4.8% vs. 1.6%, p = 0.002) RCC, and less likely to be papillary (12.0% vs. 18.7%, p = 0.002) or chromophobe (3.1% vs. 6.7%, p = 0.006) RCC compared to patients with non-metastatic disease, respectively. The 2-year, 5-year, and 10-year survival was significantly higher in non-metastatic patients compared to patients with metastatic disease present at time of surgery (87.0% vs. 42.4%, 70.0 vs. 21.8%, 50.0% vs. 16.5%, p < 0.001, respectively). Conclusions: Over the last 15 years, patients with non-metastatic disease at the time of surgery have improved survival rates and are more likely to have papillary or chromophobe primary tumors than patients with metastatic disease. UISS stratification of patients with RCC provides a unique tool for risk assignment and outcome analysis to help determine follow-up regimens and eligibility for clinical trials. [Table: see text] No significant financial relationships to disclose.

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Introduction: Patient-reported outcome measures (PROMs) are used increasingly, but for young patients with hip complaints, traditional scoring systems have a ceiling effect that limits their usability. We developed and validated the Super Simple Hip (SUSHI) score, a PROM specifically targeted at younger patients with hip complaints. Although the SUSHI measured hip problems adequately, the responsiveness of its activity rating component was considered inadequate. Consequently, we replaced the activity rating component by the University of California, Los Angeles (UCLA) activity scale. The aim of this study was to validate the resulting new 10-item SUSHI-UCLA score. Methods: A prospective multicentre observational cohort study was performed. Patients between 18 and 59 years, who visited the Orthopaedic Department with hip complaints, completed the SUSHI-UCLA and hip osteoarthritis outcome score (HOOS) twice before their 1st appointment, and once 16 months after. Results: 142 patients were included (mean age 49 years; SD 8.8). The SUSHI-UCLA score correlated well with the HOOS, both before and after treatment (Spearman’s rho = 0.739 and 0.847, respectively, both p < 0.001). The responsiveness of both the SUSHI-UCLA score and the UCLA activity scale was high (standardised response mean = 2.51 and 1.35 respectively). The reproducibility was good (interclass correlation coefficient for agreement = 0.962). The minimal important change was 21.2. No significant floor or ceiling effect was observed. Conclusion: The SUSHI-UCLA score is an adequate PROM to measure hip complaints in younger patients and includes a validated activity rating.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Object Medical and surgical management of low-grade gliomas (LGGs) is complicated by a highly variable clinical course. The authors recently developed a preoperative scoring system to prognosticate outcomes of progression and survival in a cohort of patients treated at a single institution (University of California, San Francisco [UCSF]). The objective of this study was to validate the scoring system in a large patient group drawn from multiple external institutions. Methods Clinical data from 3 outside institutions (University of Utah, Toronto Western Hospital, and University of California, Los Angeles) were collected for 256 patients (external validation set). Patients were assigned a prognostic score based upon the sum of points assigned to the presence of each of the 4 following factors: 1) location of tumor in presumed eloquent cortex, 2) Karnofsky Performance Scale (KPS) Score ≤ 80, 3) age > 50 years, and 4) maximum diameter > 4 cm. A chi-square analysis was used to analyze categorical differences between the institutions; Cox proportional hazard modeling was used to confirm that the individual factors were associated with shorter overall survival (OS) and progression-free survival (PFS); and Kaplan–Meier curves estimated OS and PFS for the score groups. Differences between score groups were analyzed by the log-rank test. Results The median OS duration was 120 months, and there was no significant difference in survival between the institutions. Cox proportional hazard modeling confirmed that the 4 components of the UCSF Low-Grade Glioma Scoring System were associated with lower OS in the external validation set; presumed eloquent location (hazard ratio [HR] 2.04, 95% CI 1.28–2.56), KPS score ≤ 80 (HR 5.88, 95% CI 2.44–13.7), age > 50 years (HR 1.82, 95% CI 1.02–3.23), and maximum tumor diameter > 4 cm (HR 2.63, 95% CI 1.58–4.35). The stratification of patients based on scores generated groups (0–4) with statistically different OS and PFS estimates (p < 0.0001, log-rank test). Lastly, the UCSF patient group (construction set) was combined with the external validation set (total of 537 patients) and analyzed for OS and PFS. For all patients, the 5-year survival probability was 0.79; the 5-year cumulative OS probabilities stratified by score group were: score of 0, 0.98; score of 1, 0.90; score of 2, 0.81; score of 3, 0.53; and score of 4, 0.46. Conclusions The UCSF scoring system accurately predicted OS and PFS in an external large, multiinstitutional population of patients with LGGs. The strengths of this system include ease of use and ability to be applied preoperatively, with the eventual goal of aiding in the design of individualized treatment plans for patients with LGG at diagnosis.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

The management of osteoarthritis of the hip in young active patients is challenging. We compared the functional outcomes and activity levels following hip resurfacing and uncemented THA in young active patients matched for age, gender and activity levels. Mean follow-up period was five years (4–7 years). Within each group there was a statistically significant improvement in the mean university of California at Los Angeles (UCLA) and Oxford Hip Score (OHS) scores following surgery. This study found no statistically significant difference in the levels of function (p= 0.82) or activity pursued (p= 0.60) after surgery between uncemented THA and hip resurfacing. The potential complications unique to hip resurfacing may be avoided by the use of uncemented THA which in itself has longer follow-up compared to resurfacing.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

AbstractHemispherectomy is a routine surgery performed for children with intractable seizures and often in the midst of a life-threatening emergency such as status epilepticus. As the following article will demonstrate, studies of neurocognitive outcome in general, and memory in specific, following hemispherectomy are mixed, although findings tend to indicate stronger lateralization of verbal memory. This is often demonstrated by loss of verbal memory following left hemispherectomy, although there are few studies focusing solely on hemispherectomy and neurocognitive outcome. We examined data from 25 patients who participated in the University of California, Los Angeles (UCLA) Pediatric Epilepsy Surgery Program (right hemisphere = 7; left hemisphere = 18). The California Verbal Learning Test-Children's Version was used as a verbal memory correlate, and the doors visual recall was used as a correlate of nonverbal memory. Based on a review of the literature, we hypothesized that (1) verbal memory would be significantly different between hemispheres with higher scores in the remaining left hemisphere; (2) nonverbal memory would be significantly different between hemispheres with higher scores in the remaining right hemisphere. Exploratory analyses were also undertaken. Implications for lateralization, medical factors, and plasticity are discussed.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Resumo Objetivo Avaliar o resultado do tratamento cirúrgico de fraturas do terço médio da clavícula. Métodos Estudo transversal retrospectivo, em que foram avaliados 36 pacientes que sofreram fratura do terço médio da clavícula, que foram tratados cirurgicamente no período de janeiro de 2012 a fevereiro de 2017. Eles foram avaliados quanto aos tipos de fratura, idade, tabagismo, material de síntese, e escores de Constant-Murley e Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA-M). Resultados As médias dos escores de Constant-Murley e UCLA-M foram de 91,59 e 31,29, respectivamente. A idade média foi de 37,62 anos, e apresentou relação estatística com o tipo de síntese (p < 0,05), mas o material de síntese não apresentou significância com a melhora de pontuação dos escores funcionais. Conclusão O tratamento cirúrgico ocasiona bons resultados funcionais após a fratura diafisária de clavícula, independente do traço da fratura, com baixa taxa de pseudoartrose.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

It is not possible to capture all the depth that composes Dr. Linda Liau: chair of the Neurosurgery Department at the University of California, Los Angeles; second woman to chair a neurosurgery program in the United States; first woman to chair the American Board of Neurological Surgery; first woman president of the Western Neurosurgical Society; and one of only a handful of neurosurgeons elected to the National Academy of Medicine. Her childhood and family history alone could fascinate several chapters of her life’s biography. Nonetheless, this brief biography hopes to capture the challenges, triumphs, cultural norms, and spirit that have shaped Dr. Liau’s experience as a successful leader, scientist, and neurosurgeon. This is a rare story. It describes the rise of not only an immigrant within neurosurgery—not unlike other giants in the field, Drs. Robert Spetzler, Jacques Marcos, Ossama Al-Mefty, and a handful of other contemporaries—but also another type of minority in neurosurgery: a woman.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Object Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery is in its infancy. The authors calculate a number of publication productivity measures for almost all academic neurosurgeons and departments within the US. Methods The h-index, g-index, m-quotient, and contemporary h-index (hc-index) were calculated for 1225 academic neurosurgeons in 99 (of 101) programs listed by the Accreditation Council for Graduate Medical Education in January 2013. Three currently available citation databases were used: Google Scholar, Scopus, and Web of Science. Bibliometric profiles were created for each surgeon. Comparisons based on academic rank (that is, chairperson, professor, associate, assistant, and instructor), sex, and subspecialties were performed. Departments were ranked based on the summation of individual faculty h-indices. Calculations were carried out from January to February 2013. Results The median h-index, g-index, hc-index, and m-quotient were 11, 20, 8, and 0.62, respectively. All indices demonstrated a positive relationship with increasing academic rank (p < 0.001). The median h-index was 11 for males (n = 1144) and 8 for females (n = 81). The h-index, g-index and hc-index significantly varied by sex (p < 0.001). However, when corrected for academic rank, this difference was no longer significant. There was no difference in the m-quotient by sex. Neurosurgeons with subspecialties in functional/epilepsy, peripheral nerve, radiosurgery, neuro-oncology/skull base, and vascular have the highest median h-indices; general, pediatric, and spine neurosurgeons have the lowest median h-indices. By summing the manually calculated Scopus h-indices of all individuals within a department, the top 5 programs for publication productivity are University of California, San Francisco; Barrow Neurological Institute; Johns Hopkins University; University of Pittsburgh; and University of California, Los Angeles. Conclusions This study represents the most detailed publication analysis of academic neurosurgeons and their programs to date. The results for the metrics presented should be viewed as benchmarks for comparison purposes. It is our hope that organized neurosurgery will adopt and continue to refine bibliometric profiling of individuals and departments.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

OBJECT Various bibliometric indices based on the citations accumulated by scholarly articles, including the h-index, g-index, e-index, and Google’s i10-index, may be used to evaluate academic productivity in neurological surgery. The present article provides a comprehensive assessment of recent academic publishing output from 103 US neurosurgical residency programs and investigates intradepartmental publishing equality among faculty members. METHODS Each institution was considered a single entity, with the 5-year academic yield of every neurosurgical faculty member compiled to compute the following indices: ih(5), cumulative h, ig(5), ie(5), and i10(5) (based on publications and citations from 2009 through 2013). Intradepartmental comparison of productivity among faculty members yielded Gini coefficients for publications and citations. National and regional comparisons, institutional rankings, and intradepartmental publishing equality measures are presented. RESULTS The median numbers of departmental faculty, total publications and citations, ih(5), summed h, ig(5), ie(5), i10(5), and Gini coefficients for publications and citations were 13, 82, 716, 12, 144, 23, 16, 17, 0.57, and 0.71, respectively. The top 5 most academically productive neurosurgical programs based on ih(5)-index were University of California, San Francisco, University of California, Los Angeles, University of Pittsburgh, Brigham & Women’s Hospital, and Johns Hopkins University. The Western US region was most academically productive and displayed greater intradepartmental publishing equality (median ih[5]-index = 18, median Ginipub = 0.56). In all regions, large departments with relative intradepartmental publishing equality tend to be the most academically productive. Multivariable logistic regression analysis identified the ih(5)-index as the only independent predictor of intradepartmental publishing equality (Ginipub ≤ 0.5 [OR 1.20, 95% CI 1.20–1.40, p = 0.03]). CONCLUSIONS The ih(5)-index is a novel, simple, and intuitive metric capable of accurately comparing the recent scholarly efforts of neurosurgical programs and accurately predicting intradepartmental publication equality. The ih(5)-index is relatively insensitive to factors such as isolated highly productive and/or no longer academically active senior faculty, which tend to distort other bibliometric indices and mask the accurate identification of currently productive academic environments. Institutional ranking by ih(5)-index may provide information of use to faculty and trainee applicants, research funding institutions, program leaders, and other stakeholders.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Purpose: To present the clinical results of arthroscopic extended rotator interval release with a stretching program for treating refractory adhesive capsulitis. Study design: Case series; level of evidence, 4. Methods: Arthroscopy-assisted extended rotator interval tissue release including anterior capsular was performed in 26 patients with refractory adhesive capsulitis. All rotator interval tissues, except the medial sling of the biceps, were excised and the excursion of the subscapularis tendon was restored and freely mobilized. The preoperative mean passive forward flexion was 101°, whereas external rotation at the side was 10°. Patients were followed for a minimum of 2 years and their visual analog scale for pain, muscle power, range of motion, Constant score, modified American Shoulder and Elbow Surgeons Shoulder Evaluation Form score, and modified University of California at Los Angeles score were recorded. Results: Visual pain scale and the aforementioned clinical scores improved postoperatively. The patients exhibited a significant postoperative difference in forward flexion, external rotation, and internal rotation. Postoperative mean passive forward flexion was 172°, whereas external rotation at the side was 58°. There was no difference in the muscle power postoperatively including abduction, internal rotation, and external rotation. Conclusions: Our study revealed satisfactory subjective and objective clinical results after a 2-year follow-up. Arthroscopy-assisted extended rotator interval release with a stretching program could be an alternative treatment for refractory adhesive capsulitis.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Background: Rotator cuff tear is a common disease for middle-aged and elderly patients, and relatively good postoperative outcomes have been reported in the literature. The aim of the study was to examine cases that underwent miniopen rotator cuff repair and to clarify their long-term clinical and imaging outcomes. Methods: A total of 68 patients who underwent a miniopen repair for small- to medium-sized rotator cuff tears with good cuff integrity and without retear on magnetic resonance imaging (MRI) at 1 year postoperatively were followed up for a minimum of 10 years (mean ± standard deviation: 11.4 ± 1.2 years) and analyzed retrospectively. One-year and 10-year postoperative University of California Los Angeles (UCLA) shoulder scores and radiographs were compared. MRI was used to evaluate cuff integrity and fatty infiltration, and staging at 1 and 10 years was compared. Results: The 1-year and 10-year postoperative UCLA scores were 33.1 points and 32.9 points, respectively. There were no significant differences between the two groups. Plain radiography showed that osteoarthritis (OA) staging was significantly worse at 10 years postoperatively compared to 1 year postoperatively. Cuff integrity was maintained at an excellent level at 10 years postoperatively. Fatty infiltration significantly progressed up to 10 years postoperatively. Conclusions: At 10 years postoperatively, OA progression and fatty infiltration were observed; however, UCLA scores and cuff integrity remained well preserved.

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Introduction: Irreparable rotator cuff tear (RCT) presents a difficult treatment challenge for the orthopaedic surgeon. Many treatment strategies with varying degrees of success have been performed over the years. One of the suggested surgical treatment options is the use of a biodegradable sub-acromial balloon spacer. Methods: A retrospective study of patients treated with sub-acromial balloon spacer between the years 2011 and 2016 was conducted. Mean follow-up time was 14.4 months. Patient charts were reviewed to evaluate the early clinical results and complications of sub-acromial spacer for irreparable RCTs. Results: The study cohort included 24 shoulders in 22 patients. The average postoperative Disability of the Arm, Shoulder and Hand score was 62.4. The average preoperative University of California at Los-Angeles Shoulder score was 10.9 and improved to 15.9 ( p = 0.001). Forty-six per cent of patients were satisfied with their clinical postoperative outcome. We found moderate–strong positive correlation ( r = 0.64) between preoperative range of motion (ROM) and general satisfaction. None of the postoperative radiographs showed an improvement regarding the proximal migration of the humeral head. In total, four (16.7%) patients experienced postoperative complications, and two (8.3%) patients required an additional surgery as a consequence of a postoperative complication. Conclusion: Our results show unsatisfactory improvement in patients with irreparable RCT treated with the sub-acromial balloon spacer. Careful patient selection with attention to preoperative ROM should be considered. Level of Evidence: Therapeutic level IV.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Resumo Objetivo Avaliar clinicamente os resultados de pacientes submetidos a tratamento cirúrgico artroscópico de instabilidade anterior do ombro. Métodos Estudo retrospectivo de 94 pacientes. Com seguimento mínimo de 24 meses, buscamos correlacionar as características dos pacientes e da cirurgia, como idade, gênero, tipo de lesão (traumática ou atraumática) e posição do paciente na cirurgia (decúbito lateral e cadeira de praia) com os resultados obtidos, avaliando o índice de recidivas de luxação, a perda de rotação lateral, a dor residual, e os escores funcionais de Carter-Rowe, da University of California at Los Angeles (UCLA) e de Constant-Murley. Resultados Observamos uma taxa de recidiva de luxação de 11,7%, perda de rotação lateral em 37,23% dos pacientes, e algum grau de dor residual em 51,6%. Obtivemos uma pontuação média no escore de Carter Rowe de 85,37, representando 86% de resultados bons/excelentes. No escore da UCLA, obtivemos 88% de resultados bons/excelentes, índice semelhante aos encontrados no escore de Constant-Murley (86%). Conclusão O tratamento artroscópico da instabilidade anterior do ombro apresenta resultados satisfatórios e baixo índice de complicações importantes, podendo ser o método de escolha para a maioria dos pacientes.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Background Frontal sinus disease and its surgical management continues to remain an area of controversy among rhinologists. This is evidenced by the multitude of surgical procedures, both external and endoscopic, that have been developed in its management. This study was performed to evaluate the safety and efficacy of frontal sinus minitrephination in combination with endoscopic frontal sinus exploration for the management of complex frontal sinus disease. Methods A retrospective chart review identified 13 patients treated with minitrephination, in conjunction with endoscopic frontal sinus exploration, at the University of California at Los Angeles Medical Center or West Los Angeles VA Medical Center from July 2004 to October 2005. Results Thirteen patients with diagnoses of chronic sinusitis (n = 10), nasal polyposis (n = 7), frontal mucocele (n = 4), allergic fungal sinusitis (n = 3), and inverting papilloma (n = 1) underwent either unilateral (n = 9) or bilateral (n = 4) minitrephination during primary or revision functional endoscopic sinus surgery. Median follow-up was 14.2 months. There were no complications attributed to the procedure, and all patients had improvement of their sinus symptoms and displayed no evidence of recurrence of their frontal sinus disease at last follow-up. Conclusion Minitrephination is a safe and effective adjunct in the management of complex frontal sinus disease, as it allows identification of the frontal recess and vigorous irrigation of the sinus contents.

APA, Harvard, Vancouver, ISO, and other styles

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Background and Objectives: The all-arthroscopic Latarjet (aL) procedure was introduced to manage recurrent shoulder instability. Our study aimed to report the outcomes of aL procedures with the Rowe, University of California-Los Angeles (UCLA), simple shoulder test (SST) scores, and range of motion (ROM) in external rotation at a minimum follow-up of 2 years. Material and Methods: A total of 44 patients presenting recurrent shoulder instability were managed with aL procedure. Clinical outcomes were assessed at a mean follow-up of 29.6 ± 6.9 months. The postoperative active ROM was measured and compared with the contralateral shoulder. The Rowe, UCLA, and SST scores were administered preoperatively and postoperatively. Results: No patients experienced infections or neuro-vascular injuries. Seven (15%) patients required revision surgery. After surgery, the external rotation was statistically lower compared to the contralateral shoulder, but it improved; clinical outcomes also improved in a statistically significant fashion. Conclusions: The aL produced good results in the management of recurrent shoulder instability, but the complication rate was still high even in the hands of expert arthroscopist.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Sarcomas of the nose and paranasal sinuses are rare malignancies. Key issues remain unresolved in the management of these tumors, particularly with regard to the role of radiotherapy. To help clarify these issues, 48 consecutive cases of nasal and paranasal sinus sarcomas treated at the University of California, Los Angeles, between 1958 and 1988 were retrospectively reviewed. Six of 16 patients managed initially with surgery alone were cured. All had negative surgical margins and 5 of the 6 had low-grade tumors. Of 5 patients with high-grade lesions treated with surgery only, 1 was rendered free of disease. Twelve patients with positive surgical margins were treated with adjuvant radiotherapy; 5 were cured with this approach. Grade and surgical margin status were found to be significantly related to outcome for sinonasal sarcoma. There were 14 patients with rhabdomyosarcoma; 3 were cured with modern combined-modality therapy. Patients with positive surgical margins should be treated with adjuvant radiotherapy. Surgical therapy is effective for low-grade lesions that are completely excised.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

✓ The authors conducted a retrospective study of 107 patients treated for syringomyelia associated with arachnoid scarring between 1976 and 1995 at the Departments of Neurosurgery at the Nordstadt Hospital in Hannover, Germany, and the University of California in Los Angeles, California. Twenty-nine patients have not been surgically treated to date because of their stable neurological status. Seventy-eight patients with progressive neurological deficits underwent a total of 121 surgical procedures and were followed for a mean period of 32 (±37) months. All patients demonstrated arachnoid scarring at a level close to the syrinx. In 52 patients the arachnoid scarring was related to spinal trauma, whereas 55 had no history of trauma and developed arachnoid scarring as a result of an inflammatory reaction. Of these, 15 patients had undergone intradural surgery, eight had suffered from spinal meningitis, three had undergone peridural anesthesia, and one each presented with a history of osteomyelitis, spondylodiscitis, and subarachnoid hemorrhage. No obvious cause for the inflammatory reaction resulting in arachnoid scarring could be ascertained for the remaining 26 patients. The postoperative neurological outcome correlated with the severity of arachnoid pathology and the type of surgery performed. Shunting of the syrinx to the subarachnoid, pleural, or peritoneal cavity was associated with recurrence rates of 92% and 100% for focal and extensive scarring, respectively. Successful long-term management of the syrinx required microsurgical dissection of the arachnoid scar and decompression of the subarachnoid space with a fascia lata graft. This operation stabilized the preoperative progressive neurological course in 83% of patients with a focal arachnoid scar. For patients with extensive arachnoid scarring over multiple spinal levels or after previous surgery, clinical stabilization was achieved in only 17% with this technique.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Purpose: We compared preoperative and postoperative measures among workers’ compensation board (WCB) recipients and non-recipients and determined the impact of WCB receipt on the 1- and 2-year outcomes of rotator cuff repair. Methods: We retrospectively reviewed patients with full-thickness rotator cuff tears who underwent arthroscopic repair between September 2011 and September 2014. Patients were divided into two groups based on WCB status: WCB recipients and non-recipients. All patients returned for follow-up functional evaluations at 1 and 2 years after the operation. Four outcome measures were evaluated: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), and range of motion (ROM). Results: Seventy patients (38 males, 32 females) were evaluated, 20 of whom were WCB recipients. At 1 year after the operation, ASES, UCLA, and VAS scores as well as abduction ROM (Abd-ROM) had improved significantly in both groups. However, non-recipients showed significantly greater improvement than did WCB recipients in ASES, UCLA, and VAS scores and in forward flexion ROM and Abd-ROM ( p = 0.000, 0.009, 0.002, 0.046, and 0.020, respectively). However, at 2 years after the operation (after the end of WCB), there were no significant differences in any clinical outcome between WCB recipients and non-recipients ( p = 0.057, 0.106, 0.075, 0.724, and 0.787, respectively). Conclusion: Although workers’ compensation recipients who underwent arthroscopic rotator cuff repair had worse outcomes while receiving WCB benefits, the outcomes were similar after WCB benefits ended.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

ResumoObjetivo Analisar a eficácia do uso de plasma rico em plaquetas (PRP) no tratamento de pacientes portadores de síndrome de impacto do manguito rotador em comparação ao tratamento com injeção subacromial de corticosteroides.Métodos O estudo é de caráter comparativo, longitudinal, duplo cego e randomizado. A evolução clínica dos pacientes foi quantificada pelas escalas The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, University of California Los Angeles (UCLA) shoulder rating scale e Constant-Murley shoulder outcome score (CMS) no dia da aplicação, e novamente após 1, 3, e 6 meses.Resultados Não foram encontradas diferenças etsatisticamente significativas (p < 0.05) ao comparar os resultados do DASH outcome measure, UCLA shoulder rating scale, e CMS dos dois grupos na admissão. Após o tratamento, ambos os grupos apresentaram melhora significativa tanto do DASH, quanto do UCLA (p < 0,05). Entretanto, o escore do CMS referente ao tratamento com corticoide mostrou-se pior no 6° mês em comparação com o escore à admissão.Conclusão Esses achados sugerem que o PRP é um tratamento seguro e que pode ser uma ferramenta útil no arsenal terapêutico contra doenças do manguito rotador, uma vez que não foram encontradas diferenças significativas entre os grupos que receberam PRP e injeção subacromial de corticosteroides.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Data on return to work and sport following open wedge high tibial osteotomy (HTO) have been underreported. Furthermore, there is no clear consensus in literature about the postoperative alignment goals following HTO. A retrospective case series was performed to evaluate return to sport and work following open wedge HTO. The University of California, Los Angeles scale, the German classification system according to the Reichsausschuß für Arbeitszeitermittlung, the Tegner score and the Knee injury and Osteoarthritis Outcome Score were used to asses the employment status, sport status and clinical outcome at the time of surgery and at final follow-up, minimum 2 years after surgery. The pre- and postoperative hip knee ankle angle (HKA) were documented. The desired postoperative alignment target was 0°-2° valgus mechanical axis. 30 open wedge HTOs were performed of which 27 patients were retrospectively included in the study. 25 out of 26 patients returned to work and 15 out of 17 patients returned to sport following surgery. Outcome scores were significantly higher after surgery. The mean postoperative HKA was 0,9° of valgus mechanical axis. This study shows excellent outcome in sport and work activity and clinical outcome after open wedge HTO. We furthermore suggest that these outcomes can be obtained with a postoperative alignment of 0°-2° of valgus mechanical axis.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Purpose Multiplex gene panel testing (MGPT) allows for the simultaneous analysis of germline cancer susceptibility genes. This study describes the diagnostic yield and patient experiences of MGPT in diverse populations. Patients and Methods This multicenter, prospective cohort study enrolled participants from three cancer genetics clinics—University of Southern California Norris Comprehensive Cancer Center, Los Angeles County and University of Southern California Medical Center, and Stanford Cancer Institute—who met testing guidelines or had a 2.5% or greater probability of a pathogenic variant (N = 2,000). All patients underwent 25- or 28-gene MGPT and results were compared with differential genetic diagnoses generated by pretest expert clinical assessment. Post-test surveys on distress, uncertainty, and positive experiences were administered at 3 months (69% response rate) and 1 year (57% response rate). Results Of 2,000 participants, 81% were female, 41% were Hispanic, 26% were Spanish speaking only, and 30% completed high school or less education. A total of 242 participants (12%) carried one or more pathogenic variant (positive), 689 (34%) carried one or more variant of uncertain significance (VUS), and 1,069 (53%) carried no pathogenic variants or VUS (negative). More than one third of pathogenic variants (34%) were not included in the differential diagnosis. After testing, few patients (4%) had prophylactic surgery, most (92%) never regretted testing, and most (80%) wanted to know all results, even those of uncertain significance. Positive patients were twice as likely as negative/VUS patients (83% v 41%; P < .001) to encourage their relatives to be tested. Conclusion In a racially/ethnically and socioeconomically diverse cohort, MGPT increased diagnostic yield. More than one third of identified pathogenic variants were not clinically anticipated. Patient regret and prophylactic surgery use were low, and patients appropriately encouraged relatives to be tested for clinically relevant results.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Abstract OBJECTIVE AND IMPORTANCE: Thromboembolic complications after cerebral aneurysm treatment with Guglielmi detachable coils (Boston Scientific/Target, Fremont, CA) are not infrequent; in a University of California, Los Angeles institutional review of 720 treated aneurysms, thromboembolic complications occurred in 2.5% of cases. The development of intraluminal thrombus during the embolization procedure, however, may be diagnosed promptly and treated effectively with appropriate therapy. This report describes the use of intravenously administered abciximab for the treatment of intraprocedural arterial thrombus encountered during the coil embolization of a recently ruptured anterior communicating artery aneurysm. CLINICAL PRESENTATION: A 45-year-old man presented with severe headache 12 days before transfer to our institution. He had no neurological deficits at admission. Previous computed tomography of the brain demonstrated subarachnoid hemorrhage, and magnetic resonance angiography from the other institution demonstrated a 4-mm anterior communicating artery aneurysm. INTERVENTION: The patient underwent Guglielmi detachable coil embolization of the aneurysm under systemic heparinization. During the embolization, however, a thrombus developed in the proximal left A2 segment. The patient was given an intravenous infusion (20 mg) of abciximab for 10 minutes, and within 15 minutes dissolution of the thrombus was observed with no angiographic evidence of distal emboli. After reversal of general anesthesia, the patient exhibited minimal right leg weakness, which resolved within 1 hour. CONCLUSION: Abciximab may be a useful adjunct for endovascular treatment of patients with cerebral aneurysms in whom intraprocedural arterial thrombus is encountered.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

“Talent attracts talent” — Jay Elliot and William L. Simon Authors of textbook The Steve Jobs Way Whether you are from the field of periodontics, trying to develop new flap techniques around implants, prosthodontics, or oral and maxillofacial surgery, you can definitely see state of the art chapters by Dr. Todd R. Schoenbaum in Newman & Carranza’s Clinical Periodontology (13th edition, 2018) [1]. Todd R. Schoenbaum, DDS, FACD is a highly experienced Associate Clinical Professor at the famous University of California, Los Angeles (UCLA) moves extremely fast bringing implant dentistry to new high levels of aesthetics and function. And what happens when a star starts to shine brightly? He starts to attract other stars. The 25 authors who are representing 11 countries and 10 world class universities contributed to Implants in the Aesthetic Zone: A Guide for Treatment of the Partially Edentulous Patient. Textbook consists of sixteen Chapters, six of which, are precisely focused on the surgical aspects. In summary, it`s a great pleasure to recommend such masterpiece to everyone who is interested in improving their implant treatment with aesthetics, predictability, and function.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Resumo Objetivo Avaliar os resultados clínicos, radiológicos, e funcionais do tratamento cirúrgico da luxação acromioclavicular aguda, utilizando a técnica de sindesmopexia coracoclavicular com duas âncoras metálicas, fixação temporária clavículo-escapular, e transferência do ligamento coracoacromial. Métodos Estudo observacional longitudinal com trinta pacientes com diagnóstico de luxação acromioclavicular aguda submetidos à cirurgia, com seguimento mínimo de seis meses, avaliados clínica, radiograficamente, e pelos escores de University of California at Los Angeles (UCLA), Disabilities of the Arm, Shoulder and Hand (DASH) e Constant-Murley. Resultados Os valores médios dos escores foram: UCLA = 32; DASH = 11,21; e Constant-Murley = 86,93, com resultados satisfatórios acima de 80%. Os resultados insatisfatórios foram relacionados à dor acromioclavicular, a testes de impacto subacromial positivos, e aos pacientes de faixa etária mais elevada (p < 0,05). Radiologicamente, valores maiores em razão da distância coracoclavicular do ombro operado, comparado com o ombro normal, foram relacionados a piores resultados, embora sem significância estatística. Não foi observada associação entre os resultados dos escores funcionais e as variáveis grau da lesão, transferência do ligamento coracoacromial, impressão clínica de perda de redução, e discinesia escapulo-torácica. Conclusão A técnica utilizada propicia uma fixação eficiente, com alto índice de satisfação segundo os escores de UCLA, Constant-Murley e DASH. Observou-se baixo índice de complicações apesar da frequência elevada de subluxação acromioclavicular radiológica residual.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Resumo Objetivo Avaliar a influência do padrão da rotura do supraespinal nas avaliações funcionais pré e pós-operatória. Métodos Estudo de coorte retrospectivo, comparando pacientes com rotura do supraespinal em crescente versus em L ou U. Incluímos pacientes submetidos ao reparo artroscópico completo do supraespinal. Não incluímos pacientes com reparo dos tendões do subescapular ou infraespinal, aqueles submetidos a cirurgia aberta, ou aqueles nos quais foi obtido apenas o reparo parcial. As escalas clínicas utilizadas foram The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) e Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), aplicadas uma semana antes e 24 meses após o procedimento. Resultados Analisamos 167 ombros (de 163 pacientes). No pré-operatório, a escala da ASES demonstrou ser significativamente superior no padrão em crescente (43,5 ± 17,6 versus 37,7 ± 13,8; p = 0,034). A escala da UCLA teve o mesmo padrão (15,2 ± 4,6 versus 13,5 ± 3,6; p = 0,028). No pós-operatório, entretanto, não ocorreu diferença significativa. De acordo com a escala da ASES, roturas em crescente tiveram 83,7 ± 18,7 pontos, e as roturas em L ou U, 82,9 ± 20,1 (p = 0,887). Respectivamente, os valores foram de 30,9 ± 4,9 e 30,5 ± 5,6 (p = 0,773) pela escala da UCLA. Conclusão As roturas em crescente e em L ou U do supraespinal apresentam resultados funcionais pós-operatórios semelhantes. No pré-operatório, os resultados funcionais são superiores nas roturas em crescente.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Purpose: Successful arthroscopic femoroplasty in patients with cam lesions have been reported in Western countries in the last two decades. However, the outcomes after arthroscopic femoroplasty in Asia have thus far only been reported in patients with borderline dysplasia and in the military population. This retrospective study was designed to evaluate the short-term clinical outcomes and radiologic outcomes after hip arthroscopy in patients with cam-type femoroacetabular impingement (FAI) at a minimum postoperative follow-up of 2 years. Methods: From January 2013 to December 2016, 204 hip arthroscopy procedures were performed. Of these cases, 62 patients (73 hips) underwent hip arthroscopy for cam-type FAI. Results: Of the 73 hips, 65 (89.0%) achieved gratified reduction or elimination of preoperative pain. The clinical outcomes showed improvement in scores from before surgery to the last follow-up: 67.1 ± 15.0 to 90.2 ± 6.3 for the modified Harris hip score ( p < 0.001), 4.7 ± 2.5 to 7.1 ± 1.4 for the University of California Los Angeles score ( p < 0.001), and 7.4 ± 1.9 to 1.8 ± 1.5 for the visual analog scale score ( p < 0.001). In radiologic assessments, significant improvement was observed in the alpha angle from a mean 60.9° to 49.5° ( p < 0.001) and in the head–neck offset from a mean of 3.3 mm to 6.3 mm ( p < 0.001). Of the 73 hips, 65 (89.0%) achieved satisfactory reduction or elimination of preoperative pain. In subgroup analysis for the sufficiency of femoroplasty (alpha angle < 55°), the clinical outcomes were not different between the two groups. Conclusion: Arthroscopic femoroplasty resulted in an 89% satisfaction at the 2-year follow-up. Therefore, hip arthroscopic femoroplasty might be an excellent alternative to open surgery and offers a greater probability of good to excellent results.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Abstract BACKGROUND: Stereotactic radiosurgery represents a noninvasive alternative treatment for intracranial metastases. OBJECTIVE: To investigate the treatment outcome of linear accelerator-based stereotactic radiosurgery (linac-SRS) for brainstem metastases. METHODS: We retrospectively reviewed our database of patients who were diagnosed with brainstem metastases and underwent linac-SRS between 1997 and 2008 at the University of California, Los Angeles. RESULTS: A total of 45 patients with 48 brainstem metastases were treated. The median target volume was 0.40 mL (range, 0.02-5.70 mL), and median prescription dose was 14 Gy (range, 10–17 Gy) at 90% isodose curve. The median survival time was 11.6 months. Longer survival time was associated with higher Karnofsky performance status. The local control rate was 92% at 6 months and 88% at 1 year. Univariate analysis demonstrated a significant relationship between local control and tumor volume (⩽0.4 mL vs &gt;0.4 mL, P = .023) and SRS mode (conventional circular arc vs dynamic conformal arc, P = .044). There was a trend toward improved local control and prescription dose &gt;14 Gy (P = .059). Two patients had brainstem complications following treatment, and the complication rate was 4.7% at 2 years. Serious morbidity occurred with 17 Gy. CONCLUSION: Linac-SRS using a median dose of 14 Gy provided excellent local control in patients with brainstem metastases less than 0.4 mL with relatively low serious morbidity. The results of the study support the use of linac-SRS for patients with brainstem metastases. We advocate 14 to 16 Gy, given the high local control rate and low complication rate with this dose.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Abstract OBJECTIVE Dural arteriovenous fistulae (DAVFs) rarely involve the clivus. This report examines the clinical presentation, angiographic findings, endovascular management, and outcome of clival DAVFs. Particular attention was given to safety and efficacy of transarterial embolization using liquid embolic agents. METHODS We reviewed the clinical and radiological data of 10 patients with spontaneous clival DAVFs who were treated endovascularly at the University of California at Los Angeles Medical Center between 1992 and 2006. RESULTS Nine patients presented with ocular symptoms and one patient experienced pulsatile tinnitus. Cerebral angiograms showed that these clival DAVFs were supplied by multiple branches of the internal and external carotid arteries. The patterns of venous drainage were from the clival veins to the cavernous sinus and superior ophthalmic vein in nine patients and to the inferior petrosal sinus in two patients. Six clival DAVFs were embolized transarterially through the clival branches of the ascending pharyngeal artery. Onyx 18 (Micro Therapeutics Inc., Irvine, CA) was used in three patients and n-butyl cyanoacrylate was used in three patients. Immediate complete angiographic obliteration was achieved in three patients. All six patients experienced an angiographic and clinical cure without any complications at 3 months. Two patients were incompletely treated using particles and coils for the relief of the symptoms. Two other patients were completely treated after the recipient clival venous structures were occluded transvenously with coils. CONCLUSION Clival DAVFs can be misdiagnosed as dural cavernous sinus fistulae. The best treatment is transarterial embolization of the dural feeders using liquid embolic agents. Transvenous occlusion of the cavernous sinus is unnecessary in most cases.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Introduction In future, outcomes following shoulder surgery may be subject to public survey. Many outcome measures exist but we do not know whether there is a consensus between shoulder surgeons in the UK. The aim of this study was to survey the preferred outcome measures used by National Health Service (NHS) shoulder surgeons operating in the UK. Methods A total of 350 shoulder surgeons working in NHS hospitals were asked to complete a short written questionnaire regarding their use of scoring systems and outcome measures. Questionnaires were sent and responses were received by post. Results Overall, 217 responses were received (62%). Of the respondents, 171 (79%) use an outcome measure in their shoulder practice while 46 (21%) do not. There were 118 surgeons (69%) who use more than one outcome measure. The Oxford shoulder score was most commonly used by 150 surgeons (69%), followed by the Constant score with 106 (49%), the Oxford shoulder instability score with 82 (38%), and the Disabilities of the Arm, Shoulder and Hand score with 54 (25%). The less commonly used outcome measures were the SF-36® and SF-12® health questionnaires with 19 (9%), the University of California at Los Angeles activity score with 8 (4%), the American Shoulder and Elbow Surgeons shoulder assessment form with 8 (4%) and the EQ-5D™ with 10 (3%). Conclusions Validated outcome measures should be adopted by all practising surgeons in all specialties. This will allow better assessment of treatments in addition to assessment of surgical performance in a transparent way.

APA, Harvard, Vancouver, ISO, and other styles

Abstract:

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the Oxford Hip Score (OHS). One-hundred-and-twenty patients who underwent primary THA were included. Various patient-related factors, including clinical scores, and surgery-related factors were examined for potential correlations with the OHS at 3, 6, and 12 months post-THA. Univariate regression analysis showed that higher preoperative University of California Los Angeles (UCLA) activity score (p = 0.027) and better preoperative OHS (p = 0.0037) were correlated with better OHS at 3 months post-THA. At 6 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.039), better preoperative OHS (p = 0.0006), and use of a cemented stem (p = 0.0071). At 12 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.0075) and better preoperative OHS (p < 0.0001). Multivariate regression analysis showed that the factors significantly correlated with better OHS were female sex (p = 0.011 at 3 months post-THA), osteoarthritis (p = 0.043 at 6 months), higher preoperative OHS (p < 0.001 at 3 and 12 months, p = 0.018 at 6 months), higher preoperative Harris Hip Score (p = 0.001 at 3 months), higher preoperative UCLA activity score (p = 0.0075 at 3 months), and the use of a cemented femoral component (p = 0.012 at 6 months). Patient- and surgery-related factors affecting post-THA PROMs were identified, although the effect of these factors decreased over time.