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We hypothesize that tethering adhesions of the quadriceps muscle are the major pathological structures responsible for a limited range of motion in the stiff arthritic knee. Forty-two modified quadriceps muscle releases were performed on 24 patients with advanced osteoarthritis scheduled for total knee arthroplasty. The ranges of motion were documented intraoperatively both before and immediately after the release. Passive flexion improved significantly in all patients (mean, 32.4° of improvement, P < .001) following a modified quadriceps release, despite any presence of osteophytes or severe deformities. These results strongly implicate adhesions of the quadriceps muscle to the underlying femur, which prevent the distal excursion of the quadriceps tendon, as the restrictive pathology preventing deep flexion in patients with osteoarthritis. 相似文献
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Kiminori Sugino MD Kaori Kameyama MD Mitsuji Nagahama MD Wataru Kitagawa MD Hiroshi Shibuya MD Keiko Ohkuwa MD Takashi Uruno MD Junko Akaishi MD Akifumi Suzuki MD Chie Masaki MD Ken-ichi Matsuzu MD Michikazu Kawano MD Koichi Ito MD 《Annals of surgical oncology》2014,21(9):2981-2986
Background
The diagnosis of minimally invasive follicular thyroid carcinoma (MIFTC) is often made histologically after thyroid lobectomy. We attempted to determine whether completion thyroidectomy should be considered necessary for all patients diagnosed with MIFTC after thyroid lobectomy.Methods
The subjects of this study were a total of 324 patients who underwent thyroid lobectomy as initial surgery at our institution between 1989 and 2010 and diagnosed histologically as MIFTC. Completion thyroidectomy was performed on 101 patients, and the other 223 patients were followed up without further treatments. Cumulative cause-specific survival (CSS) rates and distant-metastasis-free survival (DMFS) rates were calculated by the Kaplan–Meier method. Differences between groups were analyzed for statistical significance by the log-rank test. Multivariate analysis was performed by using the Cox proportional hazards model.Results
During the follow-up period, 39 patients were diagnosed with distant metastasis, and 7 patients died of their disease. Age at the initial surgery was found to be a significant factor related to DMFS in both the univariate and multivariate analysis and to also be related to CSS in the univariate analysis. Completion thyroidectomy did not have a significant effect on DMFS or CSS according to the results of the univariate analysis, but it had significant effect on DMFS according to the results of the multivariate analysis.Conclusions
Although we were unable to demonstrate sufficient statistical evidence that completion thyroidectomy improved the outcome of MIFTC patients, it is noteworthy none of the patient who underwent completion thyroidectomy died of the disease. 相似文献6.
Mehmet İlker Gökçe Parviz Hajıyev Evren Süer Yusuf Kibar Mesrur Selçuk Sılay Serhat Gürocak Hasan Serkan Doğan Hasan Cem Irkılata Tayfun Oktar Bülent Önal Erim Erdem Yüksel Cem Aygün Can Balcı Ahmet Rüknettin Arslan Cevdet Kaya Tarkan Soygür Şaban Sarıkaya Serdar Tekgül Berk Burgu 《The Journal of urology》2014
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Simon W. Young John Mutu-Grigg Christopher M. Frampton John Cullen 《The Journal of arthroplasty》2014
Longer operative times may be required in complex total knee arthroplasty (TKA), however little is known about outcomes in procedures performed rapidly. We analysed 58,009 primary TKAs from the New Zealand National Joint Registry. The mean surgical duration was 89 minutes, and 50% of procedures lasted between 60 and 89 minutes. There was no difference in adjusted revision rates for groups lasting between 40 and 120 minutes, however procedures lasting > 120 minutes had significantly higher revision rates. There was a higher revision rate in TKAs lasting < 40 minutes (0.71 vs 0.48 revisions per 100 component years) but this was not statistically significant (P = 0.1). For primary TKAs lasting less than 120 minutes, further shortening operative time did not improve outcome, and very rapid procedures (< 40 minutes) may lead to an increased risk of revision. 相似文献
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Moazami N Diodato MD Moon MR Lawton JS Pasque MK Herren RL Guthrie TJ Damiano RJ 《Journal of cardiac surgery》2004,19(5):444-448
BACKGROUND: The surgical treatment of mitral valve regurgitation (MR) at the time of aortic valve replacement (AVR) remains controversial. The purpose of this study was to evaluate the change in severity of MR following isolated AVR, and to determine survival benefit. METHODS: Between 1991 and 2001, 250 patients underwent isolated AVR; 196 patients had concomitant functional MR. Follow-up transthoracic echocardiography (TTE) was available on 107 patients, with a median of 818 +/- 752 days. Aortic valve was stenotic in 77 and regurgitant in 30 patients. RESULTS: Mean age was 67 +/- 15 years and 57 (53%) were male. Preoperative MR was trivial (1+) in 27 (25%), mild (2+) in 44 (41%), moderate (3+) in 29 (27%), and severe (4+) in 7 (7%). At follow-up TTE, MR improved by 1 or 2 grades in 48 patients (45%). Of patients with preoperative 2+ MR, 19 (43%) improved, 16 (36%) remained unchanged, and 9 (21%) worsened. Although some patients with preoperative 3+ MR exhibited improvement, 11 (38%) remained with moderate-to-severe MR. Of those with a preoperative MR of 4+, 3 (71%) improved, and 4 remained with 3-4+ MR. For patients with preoperative 1 to 2+ MR, survival at 3 years was 98% compared to 78% for those with 3 to 4+ MR (p = 0.038). CONCLUSION: Functional MR does not always improve after isolated AVR. Survival is lower for patients with preoperative 3 to 4+ MR. Moderate-to-severe MR should be repaired at the time of aortic valve surgery. 相似文献
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The aim of this study was to investigate whether a standard course of outpatient physiotherapy improves the range of knee motion after primary total knee arthroplasty. One hundred and fifty patients were randomly assigned into one of 2 groups. One group received outpatient physiotherapy for 6 weeks (group A). Another received no outpatient physiotherapy (group B). Range of knee motion was measured preoperatively and at 1-year review. Validated knee scores and an SF-12 health questionnaire were also recorded. Although patients in group A achieved a greater range of knee motion than those in group B, this was not statistically significant. No difference either was noted in any of the outcome measures used. In conclusion, outpatient physiotherapy does not improve the range of knee motion after primary total knee arthroplasty. 相似文献
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NS Kalson E Mulgrew G Cook ME Lovell 《Annals of the Royal College of Surgeons of England》2009,91(4):292-295
INTRODUCTION
Delay in surgery for fractured neck of femur is associated with increased mortality; it is recommended that patients with fractured neck of femur are operated within 48 h. North West hospitals provide dedicated trauma lists, as recommended by the British Orthopaedic Association, to allow rapid access to surgery. We investigated trauma list provision by each trust and its effects on the time taken to get neck of femur patients to surgery and patient survival.PATIENTS AND METHODS
The number of trauma lists provided by 13 acute trusts was determined by telephone interview with the theatre manager. Data on operating delays, reasons for delay and 30-day mortality were obtained from the Greater Manchester and Wirral fractured neck of femur audit.RESULTS
A total of 883 patients were included in the audit (35–126 per hospital). Overall, 5–15 trauma lists were provided each week, and 80% of lists were consultant-led. Of patients, 31.8% were operated on within 24 h and 36.9% were delayed more than 48 h; 37.7% of delays were for non-medical reasons. The 30-day mortality rates varied between 5–19% (mean, 11.8%). There were no significant relationships between the number of trauma lists and these variables. When divided into hospitals with > 10 lists per week (n = 6) and those with < 10 lists per week (n = 7) there were no significant differences in 48-h delay, non-medical delay or mortality. However, 24-h delay showed a trend to be lower in those with > 10 lists (34.6% of patients versus 28.9%; P = 0.09).CONCLUSIONS
Most trusts provided at least one dedicated daily list. This study shows that extra lists may enable trusts to cope better with fractured neck of femur but do not change mortality. 相似文献15.
Background Nipple–areola complex (NAC) preservation is a new revolution in breast cancer surgery and breast reconstruction, if reliability
and safety are considered. The latissimus dorsi muscular flap is a versatile flap that is gaining renewed popularity for immediate
breast reconstruction with development of modifications. We are introducing nipple-sparing mastectomy (NSM) for Egyptian patients
with breast carcinoma and reporting our results with a new modification of the extended latissimus dorsi muscular flap.
Methods Between July 2005 and August 2006; forty-one patients with stage I to III breast carcinoma had NSM and immediate breast reconstruction.
We performed a new modification to the extended latissimus dorsi muscular flap that allowed us to obtain enough autologous
tissue to reconstruct the breast without implant or back incision. The postoperative aesthetic results with specific view
of the preserved NAC were evaluated.
Results We applied both an objective and subjective aesthetic result to our monitoring. Aesthetic grading results of breast reconstruction
were as follows: excellent in 31, good in 6, fair in 2, poor in 2. Both reconstructed breast and donor site complications
were minor. Patients are followed for a median follow-up of 7.9 months (range: 4–11 months). In this short period of follow-up,
no local recurrence or distant failure has been observed.
Conclusions Nipple-sparing mastectomy with immediate breast reconstruction using modified extended latissimus dorsi muscular flap allows
single-stage, totally autologous reconstruction with a satisfactory aesthetic result, low morbidity, and good quality of life. 相似文献
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Use of larger diameter femoral heads has been popularised in total hip arthroplasty (THA). Recent studies have implicated larger femoral heads in early failure. We evaluated what effect the size of the femoral head had on the early functional outcome in order to determine the optimal head size for the maximal functional outcome. There were 726 patients who underwent elective THA and were divided into 3 groups according to head size then compared with respect to functional outcome scores and dislocation rates. This study failed to show that increasing the size of the femoral head significantly improved the functional outcome at 1 year after total hip arthroplasty but that the use of a 36 mm or greater femoral head did reduce the dislocation rate. 相似文献
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Jasinski MJ Wos S Kadziola Z Wenzel-Jasinska IA Spyt TJ 《Journal of cardiac surgery》2000,15(5):354-361
BACKGROUND: The purpose of our research was to evaluate the functional recovery and homeostasis of myocardium during simultaneous continuous retrograde and antegrade cardioplegia versus continuous retrograde cardioplegia. METHODS: Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted. RESULTS: In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group. CONCLUSIONS: Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone. 相似文献
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M. W. J. M. Wouters MD H. E. Karim-Kos PhD S. le Cessie PhD B. P. L. Wijnhoven MD PhD L. P. S. Stassen MD PhD W. H. Steup MD PhD H. W. Tilanus MD PhD R. A. E. M. Tollenaar MD PhD 《Annals of surgical oncology》2009,16(7):1789-1798
Background The volume–outcome relationship for complex surgical procedures has been extensively studied. Most studies are based on administrative
data and use in-hospital mortality as the sole outcome measure. It is still unknown if concentration of these procedures leads
to improvement of clinical outcome. The aim of our study was to audit the process and effect of centralizing oesophageal resections
for cancer by using detailed clinical data.
Methods From January 1990 until December 2004, 555 esophagectomies for cancer were performed in 11 hospitals in the region of the
Comprehensive Cancer Center West (CCCW); 342 patients were operated on before and 213 patients after the introduction of a
centralization project. In this project patients were referred to the hospitals which showed superior outcomes in a regional
audit. In this audit patient, tumor, and operative details as well as clinical outcome were compared between hospitals. The
outcome of both cohorts, patients operated on before and after the start of the project, were evaluated.
Results Despite the more severe comorbidity of the patient group, outcome improved after centralizing esophageal resections. Along
with a reduction in postoperative morbidity and length of stay, mortality fell from 12% to 4% and survival improved significantly
(P = 0.001). The hospitals with the highest procedural volume showed the biggest improvement in outcome.
Conclusion Volume is an important determinant of quality of care in esophageal cancer surgery. Referral of patients with esophageal cancer
to surgical units with adequate experience and superior outcomes (outcome-based referral) improves quality of care. 相似文献