280 research outputs found
Extended lymph node dissection without routine spleno-pancreatectomy for treatment of gastric cancer : low morbidity and mortality rates in a single center series of 250 patients
No full textBackground and Objectives: To verify the hypothesis that avoidance of routine splenectomy and distal pancreatectomy in a modified D-2 resection for gastric cancer can significantly lower the complications rate of this procedure in a population of Western patients. Methods: A series of 250 consecutive Italian patients suffering from localized, histology-proven gastric cancer was submitted to gastrectomy and extended D-2 lymphadenectomy for treatment of their disease during an 8-year period (1994-2002) at the European Institute of Oncology in Milano, Italy. Caudal pancreas and spleen were routinely preserved, unless the tumor was not closely adjacent to or directly invading these organs. Postoperative morbidity, overall mortality, and length of hospital stay were recorded. Results: One hundred forty patients underwent total gastrectomy and 110 a subtotal distal one; splenectomy was performed in 8 cases and spleno-pancreatectomy in 15. The postoperative morbidity rate was 18%, the mortality rate was 1.2% and 9 patients experienced re-operation. The median length of stay was 14.8 days. Conclusions: These results compete favorably with those reported after standard D-1 gastrectomy in Western patients series. D-2 gastrectomy with spleen and pancreas routine preservation can be considered a safe treatment for gastric cancer in Western patients, at least in experienced centers
Teaching adults to read better and faster : results from an experiment in Burkina Faso
No full textTwo cognitively oriented methods were tested in Burkina Faso to help illiterates learn to read more efficiently. These were (a) speeded reading of increasingly larger word units and (b) phonological awareness training to help connect letters to speech. Learners were given reading tests and a computerized reaction time test. Although the literacy courses were shortened by the arrival of rains and government delays, the piloted methods helped adults read better than those in the standard"control"classes. Learners enrolled in the experimental classes performed better on the outcome tests than did learners enrolled in control classes. Ninety percent of the possible comparisons between treatment classes and control classes favored classes receiving treatments, and 72 percent of the measurements in favor of treatments were statistically significant. The evidence suggests that phonological awareness training is particularly effective in situations where the training period was short, and that rapid reading was more advantageous in longer training situations. Overall, the results are indicative of the potential that scientifically backed methods have in making adult literacy instruction more effective. However, due to the short duration of the classes (3-4 months) learners apparently did not receive sufficient practice to consolidate skills. Literacy skills may still be prone to being forgotten if readers do not learn to read automatically and if opportunities to read are few.Curriculum&Instruction,Teaching and Learning,Nonformal Education,Primary Education,ICT Policy and Strategies,Nonformal Education,ICT Policy and Strategies,Primary Education,Teaching and Learning,Curriculum&Instruction
Rapid malaria diagnostic tests vs. clinical management of malaria in rural Burkina Faso: safety and effect on clinical decisions. A randomized trial
No full textOBJECTIVES: To assess if the clinical outcome of patients treated after performing a Rapid Diagnostic Test for malaria (RDT) is at least equivalent to that of controls (treated presumptively without test) and to determine the impact of the introduction of a malaria RDT on clinical decisions. METHODS: Randomized, multi-centre, open clinical trial in two arms in 2006 at the end of the dry and of the rainy season in 10 peripheral health centres in Burkina Faso: one arm with use of RDT before treatment decision, one arm managed clinically. Primary endpoint: persistence of fever at day 4. Secondary endpoints: frequency of malaria treatment and of antibiotic treatment. RESULTS: A total of 852 febrile patients were recruited in the dry season and 1317 febrile patients in the rainy season, and randomized either to be submitted to RDT (P_RTD) or to be managed presumptively (P_CLIN). In both seasons, no significant difference was found between the two randomized groups in the frequency of antimalarial treatment, nor of antibiotic prescription. In the dry season, 80.8% and 79.8% of patients with a negative RDT were nevertheless diagnosed and treated for malaria, and so were 85.0% and 82.6% negative patients in the rainy season. In the rainy season only, both diagnosis and treatment of other conditions were significantly less frequent in RDT positive vs. negative patients (48.3% vs. 61.4% and 46.2% vs. 59.9%, P = 0.00 and 0.00, respectively). CONCLUSION: Our study was inconclusive on RDT safety (clinical outcome in the two randomized groups), because of an exceedingly and unexpectedly low compliance with the negative test result. Further research is needed on best strategies to promote adherence and on the safety of a test based strategy compared with the current, presumptive treatment strategy
RESECTION OF A GIANT MEDIASTINAL LEIOMYOSARCOMA
No full textABSTRACT Primary leiomyosarcomas of the lung are rare tumors. We report a case of 49-year-old female with history of cough, breathless at rest, right sided chest pain. Chest CT showed a huge (16 cm) mediastinal mass located on the right mediastinum encasing the right main pulmonary artery and infiltrating the main right bronchus and pericardium. The tumor was resected with combined pericardiectomy and pnemonectomy via hemiclamshell incision. This surgical access provided an adequate exposure of the chest “blind zones” and it allowed a radical and safe surgical resection of lung, pleura, pericardium and diaphragm. The final diagnosis showed a low grade differentiation leiomyosarcoma
ROUTINARY USE OF FIBRIN SEALANTS TO PREVENT PROLONGED AIR LEAK IN THORACIC SURGERT: OUR EXPERIENCE
No full textIntroduction: prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery. It is associatred with increased significant morbidity, lower quality of life, longer hospital stay and higher hospital costs. Since its great clinical and economic burden, it is important to establish the feasibility and the effectiveness of the routinary preventive use of a fibrin sealant in order to reduce the incidence of prolonged air leaks. Patients and methods: this is a randomized study on 189 adult patients - 118 men (62,4%) and 71 women (37,6%) aged from 39 to 87 y.o. (mean age 68,3 y.o.) - who underwent lung surgery (lobectomy or bilobectomy) with intraoperatory detection of air leakage, from January 2013 to December 2017, at Department of Thoracic Surgery in "Ospedale Maggiore Carlo Alberto Pizzardi" (Bologna, Italy) and Department of Thoracic Surgery in "Paolo Giaccone" Teaching Hospital (Palermoo, Italy). Patients were randomnly assigned to the "Glue" arm (90 patients) or the "Control" group (99 patients). We only used stapler or manual suture to acheve aerostasis. In addition, we used a fibrin sealant ("glue") to cover the suture line on patients in the "glue" arm. The primary endpoints were incidence of prolonged air leaks, days with chest tube and mean hospital stay. Results: in the "Glue" arm we experienced ONLY 1 prolonged air leak (1,1%), while in the "Control group) there were 8 leaks. (8,1%). Patients kept chest tube for average 4,15 days in the "Glue" arm and 4,45 days in the "control" group. The mean hospital stay was average 7,4 days for the 2Glue" arm, while 9.1 days in the "control" group. Conclusions: according to our experience it seems that the routinary preventive use of a fibrin sealant results in a lower incidence of prolonged air leaks, a shorter hospital stay with lower hospital costs, representing a cost-effective, feasible and effective system to decrease morbility and mortality among surgical patients
CHOROIDAL METASTASIS FROM LUNG ADENOCARCINOMA: A RARE CASE REPORT
No full textThe choroid is the most common site for intraocular metastatic disease. Orbital metastasis as metastatic site of lung adenocarcinoma is very rare and in literature a very exiguos number of cases is present. This is a case report of a wiìoman with history of lung adenocarcinoma and, after surgery, detection of a choroidal mass described as lung metastasis, responding to Gefinitib therapy. However a biopsy was non performed. After two years there was a great dimension decrement of the lung metastasis but she is still suffering from recurrent pleural effusion, with pleural thickening biopsied and diagnosed as recurrence disease
Bayesian variable selection in modelling geographical heterogeneity in malaria transmission from sparse data : an application to Nouna Health and Demographic Surveillance System (HDSS) data, Burkina Faso
No full textQuantification of malaria heterogeneity is very challenging, partly because of the underlying characteristics of mosquitoes and also because malaria is an environmentally driven disease. Furthermore, in order to assess the spatial and seasonal variability in malaria transmission, vector data need to be collected repeatedly over time (at fixed geographical locations). Measurements collected at locations close to each other and over time tend to be correlated because of common exposures such as environmental or climatic conditions. Non- spatial statistical methods, when applied to analyze such data, may lead to biased estimates. We developed rigorous methods for analyzing sparse and spatially correlated data. We applied Bayesian variable selection to identify the most important predictors as well as the elapsing time between climate suitability and changes in entomological indices.; Bayesian geostatistical zero-inflated binomial and negative binomial models including harmonic seasonal terms, temporal trends and climatic remotely sensed proxies were applied to assess spatio-temporal variation of sporozoite rate and mosquito density in the study area. Bayesian variable selection was employed to determine the most important climatic predictors and elapsing (lag) time between climatic suitability and malaria transmission. Bayesian kriging was used to predict mosquito density and sporozoite rate at unsampled locations. These estimates were converted to covariate and season-adjusted maps of entomological inoculation rates. Models were fitted using Markov chain Monte Carlo simulation. The results show that Anophele. gambiae is the most predominant vector (79.29%) and is more rain-dependant than its sibling Anophele. funestus (20.71%). Variable selection suggests that the two species react differently to different climatic conditions. Prediction maps of entomological inoculation rate (EIR) depict a strong spatial and temporal heterogeneity in malaria transmission risk despite the relatively small geographical extend of the study area. CONCLUSION: Malaria transmission is very heterogeneous over the study area. The EIR maps clearly depict a strong spatial and temporal heterogeneity despite the relatively small geographical extend of the study area. Model based estimates of transmission can be used to identify high transmission areas in order to prioritise interventions and support research in malaria epidemiology
CT-GUIDED TRANSTHORACIC NEEDLE BIOPSY: ADVANTEGES IN HISTOPATHOLOGICAL AND MOLECULAR TESTS
No full textAim: The present study aimed to demonstrate that computed tomography-guided transthoracic needle biopsy (TTNB) is a safe procedure that gives a more accurate pre-operative tissue diagnosis for peripheral lung nodules than transthoracic needle aspiration, obtaining suitable samples for molecular test in lung adenocarcinomas. Patients and methods: Between December 2016 and March 2018 at Thoracic Surgery Department of the University of Palermo - Policlinico Paolo Giaccone Hospital, TTNB was performed in 42 patients with computed tomography-detected peripheral lung nodules > 10 mm, using 16-18 -Gauge tru-Cut needles. Results: With TTNB, we have estimated an accuracy for tissue diagnosis of 97,6%. At the molecular test, EGFR overexpression and ALK mutation resulted positive for 12/23 patients with lung adenocarcinoma. Conclusion: TTNB has showed a low rate of complications and it is adoptable as standard diagnostic procedure for peripheral lung nodules
POSTOPERATIVE COMPLICATIONS,PAIN AND QUALITY OF LIFE AFTER THORACOSCOPIC OF THOREACOTOMIC LOBECTOMY FOR LUNG CANCER
No full textAim: Thoracoscopic lobectomy is superior to thoracotomy, but the evidence for this assumption is low. We present a comparison between thoracotomy and thoracoscopy in term of postoperative complications, mortality, postoperative, hospital stay and quaklity of life. Patients and methods: This is a rectrospective analysis of 224 lobectomies in 24-months. 128 patients (57.1%) were operated by thoracotomy; 96 patients (42.9%) by videothoracoscopy. Results: Major complications were observed in 4/128 (3.1%) in thoracotomy group and in 1/96 (16.7%) thoracoscopy. Thoracoscopy patients had a shorter hospital stay. Conclusion: our study shows an advantage of thorascopy over thoracotomy but furher studies are needed
Spatiotemporal assessment of irrigation performance of the Kou Valley Irrigation Scheme in Burkina Faso using satellite remote sensing-derived indicators
No full textTraditional methods based on field campaigns are generally used to assess the performance of irrigation schemes in Burkina Faso, resulting in labor-intensive, time-consuming, and costly processes. Despite their extensive application for such performance assessment, remote sensing (RS)-based approaches remain very much underutilized in Burkina Faso. Using multi-temporal Landsat images within the Python module for the Surface Energy Balance Algorithm for Land model, we investigated the spatiotemporal performance patterns of the Kou Valley irrigation scheme (KVIS) during two consecutive cropping seasons. Four performance indicators (depleted fraction, relative evapotranspiration, uniformity of water consumption, and crop water productivity) for rice, maize, and sweet potato were calculated and compared against standard values. Overall, the performance of the KVIS varied depending on year, crop, and the crop’s geographical position in the irrigation scheme. A gradient of spatially varied relative evapotranspiration was observed across the scheme, with the uniformity of water consumption being fair to good. Although rice was the most cultivated, a shift to more sweet potato farming could be adopted to benefit more from irrigation, given the relatively good performance achieved by this crop. Our findings ascertain the potential of such RS-based cost-effective methodologies to serve as basis for improved irrigation water management in decision support tools
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