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991.
992.
Alvaro Sanabria Carl E. Silver Carlos Suárez Ashok Shaha Avi Khafif Randall P. Owen Alessandra Rinaldo Alfio Ferlito 《European archives of oto-rhino-laryngology》2013,270(9):2383-2395
One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. 相似文献
993.
S. D. Chowdhury Ashok Chacko B. S. Ramakrishna A. K. Dutta J. Augustine A. K. Koshy E. G. Simon A. J. Joseph 《Indian pediatrics》2013,50(11):1016-1019
Objective
To evaluate the etiology, presentation, complications and management of chronic pancreatitis in children.Design
Retrospective chart review.Setting
Gastroenterology department at Christian Medical College and Hospital, Vellore, India between January 2005 and December 2010.Participants
99 Children (<18 yrs) diagnosed with chronic pancreatitis based on clinical and imaging features.Main outcome measures
Etiology, clinical presentation, complications and management of chronic pancreatitis in children.Results
Of 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis, of which 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea. Pancreatic calcification was seen in 69 (69.7%). 68 (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% vs. 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst (17.1%) and ascites (9.1%) were the most common complications. All children were treated with pancreatic enzyme supplements for pain relief. 57 patients were followed up. With enzyme supplementation, pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27 %) had pain relief. There was no death.Conclusions
Idiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas. 相似文献994.
Venkatesan Chakrapani Peter A. Newman Ashok Row Kavi 《Culture, health & sexuality》2013,15(8):938-951
Quantitative studies among men who have sex with men in India have shown high levels of unprotected anal sex. However, there is little information about the contexts in which such men may not use condoms. Relevant information on these contexts can assist in designing HIV prevention programmes to remove barriers to consistent condom use. As part of a larger study on sexual and social networks, we explored the contexts in which men who have sex with men did not use condoms, with a focus on personal, interpersonal and structural levels of experience. Data indicate the importance of understanding the different contexts that lead to unprotected sex but also reveal that the concept ‘context’ itself as a complex variable to consider in research of this kind, as research subjects interpret their social worlds and sexual risks in subtle and varied ways. Based on this viewpoint we make recommendations regarding HIV prevention. 相似文献
995.
Sudhir M. Naik Ashok M. Shenoy A. Nanjundappa Rajshekar Halkud Purshottam Chavan K. Sidappa Sumit Gupta 《Indian journal of otolaryngology and head and neck surgery》2013,65(2):162-167
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease, characterized by hypersensitivity of the skin to ultraviolet (UV) radiation leading to high incidence of skin cancer and progressive neurological complications. It results in premature development of neoplasias due to an exacerbated hypersensitivity to UV radiation causing premalignant and malignant lesions leading to death in early adulthood. Two cases of clinical features of xeroderma pigmentosa with skin lesions were managed in our department. One had multiple clusters of basal and squamous cell carcinomas and the other had malignant melanomas and right neck nodes. Both were treated with multiple wide excisions and the neck node were surgically managed with radical neck dissections. Skin malignancies were common in the sun exposed areas and patients were advised regular 3 months follow up. The disease is ultimately fatal, life can be prolonged by simple preventive measures to minimize sun exposure. Comprehensive multimodality management includes patient education and counselling for the psychosomatic disorder and genetic counseling remains the most important preventive measure. 相似文献
996.
Biju Pottakkat Abhimanyu Kapoor Anand Prakash Rajneesh Kumar Singh Anu Behari Ashok Kumar Vinay K. Kapoor Rajan Saxena 《Journal of gastrointestinal cancer》2013,44(1):33-40
Introduction
Radical resection to achieve R0 status remains the only potential curative option in patients with gall bladder cancer (GBC). This study was aimed to evaluate the efficacy of an extended criterion of radical resection to achieve R0 status in GBC.Methods
A triple-phase CT with 3D reconstruction was done in all patients. A standard resectability criterion was followed in all patients. A minimum of liver segment 4B + 5 resection and radical lymphadenectomy including the para-aortic areas were undertaken in all patients. Adjacent organectomy was added as required.Results
Between November 2008 and April 2011, 59 patients with GBC underwent operation and 40 (resectability, 68 %) underwent resection. The resectional procedures performed were segmentectomy 4B + 5 in 31 (78 %), median sectorectomy in 2 (5 %), extended right hepatectomy in 3 (8 %), and hepatopancreaticoduodenectomy in 4 (10 %) patients. Postoperative complications occurred in 24 (60 %) patients. Two patients died postoperatively. A total of 829 lymph nodes were harvested and the median lymph node count was 18 (4–77). Twenty-three (58 %) patients had lymph node metastases. Twenty-eight of 40 (70 %) had disease limited till N1 nodes. Metastases up to N2 lymph nodes were seen in 12 (30 %). American Joint Committee on Cancer seventh edition stages were I—2 (5 %) patients, II—5 (13 %), III—19 (48 %), and IV—14 (35 %). R0 resection was achieved in 33 (83 %) patients. Four patients had recurrence and one died of recurrence. All other patients are alive till the last follow-up.Conclusions
Assessment with triple-phase CT with 3D reconstruction can produce high resectability rate in GBC. Extended criterion of radical resection results in R0 status in more than 80 % of patients with GBC. 相似文献997.
998.
Subramanian S Sankar MJ Deorari AK Velpandian T Kannan P Prakash GV Agarwal R Paul VK 《Indian pediatrics》2011,48(9):689-696
Objective
To compare phototherapy devices based on their physical and photo-biological characteristics viz spectral properties, maximum and mean irradiance, treatable percentage of body surface area, decay of irradiance over time and in vitro photoisomerisation of bilirubin. 相似文献999.
1000.
Vorona GA Ceschin RC Clayton BL Sutcavage T Tadros SS Panigrahy A 《Pediatric radiology》2011,41(9):1174-1182