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At least 253 records · Page 14Linked to original sources

PubMed1997

Induction therapy for clinical T4 oesophageal carcinoma; a plea for continued surgical exploration.

OBJECTIVE: Complete resection of a locally advanced oesophageal carcinoma is not always feasible when invading mediastinal structures. The use of induction therapy prior to surgical exploration in patients with these clinical T4 tumours is anticipated to improve the resectability rate. METHODS: Patients, 18, who presented with a carcinoma of the thoracic oesophagus with clinical invasion into the carina (n = 6), trachea (n = 5), aorta (n = 4), lung (n = 2) and diaphragm (n = 1) were treated with concurrent chemotherapy and radiotherapy followed by surgical exploration. Follow-up was complete (mean of 17 +/- 3 months in all patients and 27 +/- 2 months in surviving patients). RESULTS: All patients completed the induction therapy with acceptable toxicity and no mortality. Subjective improvement in dysphagia was substantial in 11 patients (in 8/11 patients (73%) however, there was still viable tumour in the resected specimen), it was minimal in six patients and absent in one patient. Objective response on imaging was complete in one patient, partial in eight patients and minimal in nine patients [in two of these nine patients (22%) nevertheless, the primary tumour had disappeared completely in the resected specimen (pT0)]. Resection was complete (R0) in 14 patients (78%) and incomplete (R1) in one patient (5%). Resection of the primary tumour was impossible (R2) in three patients (17%) because of macroscopic airway (n = 2) and hilar (n = 1) invasion on exploration. In these three patients the tumour was bypassed using a retrosternal split stomach. One patient was proven at the time of surgery to have a previously unidentified lung metastasis. In three patients (17%), no residual tumour cells were found in the resected oesophagus nor in the lymph nodes (pT0N0M0). There have been no in-hospital deaths. Actuarial 3 year survival was 43% in all patients, 55% in completely resected patients and 100% in sterilized patients (pT0N0M0). Median survival was 18 months in all patients. CONCLUSIONS: Chemo/radiotherapy followed by surgery in patients with a clinical T4 oesophageal carcinoma is feasible with acceptable toxicity and no treatment-related mortality. Operability and resectability rate were high (100 and 83%, respectively) compared with historical controls. The primary tumour disappeared completely (pT0N0-1M0-1) in 28%. Tumour sterilization rate was 17%. Survival looks promising compared with historical controls. Subjective neither objective response following induction therapy clearly correlated with the final pTNM staging. This indicates that, in the absence of tumour progression, neither the patient nor the treating physician should jeopardize the chance for ultimate cure by denying surgical exploration following induction therapy.

Actuarial Analysis↗

PubMed2005

On-table diagnostic accuracy and the clinical significance of routine exploration in open appendectomies.

INTRODUCTION: The current practice of further exploration for other intra-abdominal pathology only when a normal appendix is found may leave other organic causes of acute abdomen undetected if the surgeon's on-table diagnostic accuracy is low. METHODS: In this retrospective study in 518 patients who underwent surgery for acute appendicitis, the on-table operative diagnosis of surgeons was correlated with the histological diagnosis of pathologists. RESULTS: Surgeons were unable to make an accurate on-table diagnosis in 14.3% of cases. The sensitivity for diagnosing normal appendices was also low at 51.3%, suggesting that almost half of normal appendices were misdiagnosed as acute appendicitis and there was no further exploration for other pathology. It was also found that surgeon's experience, patient gender and patient age had no significant effect on diagnostic accuracy. CONCLUSION: Based on these results, it seems that the on-table diagnostic accuracy in open appendectomies is low and surgeons' on-table diagnosis should not be the determining factor for whether further exploration is necessary. Exploration for other intra-abdominal pathology should be routine irrespective of the on-table diagnosis, the surgeon's experience and patient gender and age. An alternative is minimal-access surgery in which inspection of other intra-abdominal organs can be performed more easily.

Adolescent↗

PubMed1999

Discovery of self: exploring, interconnecting and integrating self (concept) and nursing.

Self concept of individual nurses is still largely unexplored in nursing. While the role of self-knowledge and self-actualisation are recognised as integral to nursing practice, little has been done to examine their relationships to self concept and nursing practice. The aim of this research study was to explore the role and significance that self concept plays in women nurses' experience of their beginning practice. The exploration examined factors which contribute to and impact on self concept within a nursing practice environment. Self concept relates to how an individual experiences oneself and is integrally linked to one's interactions and relationships with others. This two phase research was situated in critical and feminist theory using reflective journalling (phase one) and story telling/narrative (phase two) as the research methods. This paper discusses the three major themes which arose in phase one of the research. Those were: exploring experiences; interconnecting personal and professional worlds; and, integrating self 'into' nursing. The paper also explores inter-subjectivity in terms of the contribution this concept makes to our understanding of research findings.

Female↗

PubMed2005

Anthropological insights into the use of race/ethnicity to explore genetic contributions to disparities in health.

Anthropological insights into the use of race/ethnicity to explore genetic contributions to disparities in health were developed using in-depth qualitative interviews with editorial staff from nineteen genetics journals, focusing on the methodological and conceptual mechanisms required to make race/ethnicity a genetic variable. As such, these analyses explore how and why race/ethnicity comes to be used in the context of genetic research, set against the background of continuing critiques from anthropology and related human sciences that focus on the social construction, structural correlates and limited genetic validity of racial/ethnic categories. The analyses demonstrate how these critiques have failed to engage geneticists, and how geneticists use a range of essentially cultural devices to protect and separate their use of race/ethnicity as a genetic construct from its use as a societal and social science resource. Given its multidisciplinary, biosocial nature and the cultural gaze of its ethnographic methodologies, anthropology is well placed to explore the cultural separation of science and society, and of natural and social science disciplines. Anthropological insights into the use of race/ethnicity to explore disparities in health suggest that moving beyond genetic explanations of innate difference might benefit from a more even-handed critique of how both the natural and social sciences tend to essentialize selective elements of race/ethnicity. Drawing on the example of HIV/AIDS, this paper demonstrates how public health has been undermined by the use of race/ethnicity as an analytical variable, both as a cipher for innate genetic differences in susceptibility and response to treatment, and in its use to identify 'core groups' at greater risk of becoming infected and infecting others. Clearly, a tendency for biological reductionism can place many biomedical issues beyond the scope of public health interventions, while socio-cultural essentialization has tended to stigmatize 'unhealthy behaviours' and the communities where these are more prevalent.

Anthropology, Cultural↗

PubMed1988

Multivariate analysis of putative measures of activity, exploration, emotionality, and spatial behavior in the hooded rat (Rattus norvegicus).

Hooded rats were tested in six situations representing the variables of activity, exploration, emotionality, and spatial preference, detection of change, and learning. The activity, exploration, and emotionality variables and spatial variables were analyzed in separate multivariate analyses, followed by an analysis of the entire set. The first of these resulted in four components: activity, exploration and emotionality, reactivity to handling, and autonomic reactivity (defecation). Four components, defined by the following variables, emerged from the spatial analysis: (a) the tendency to circle, circling direction, and spatial learning; (b) heading error in spatial learning and reversal and open-field directional preference; (c) spatial reversal and direction of turn to escape restraint; and (d) detection of change in spatial arrangement and directional preference in the detection task. The final analysis investigated relations between the activity, exploration, and emotionality variables and the spatial variables, finding only two. The clear dimensionality of these behavioral repertoires emphasizes how important it is to recognize the distinctions among them.

Animals↗

PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗

PubMed2002

Experience and meaning of user involvement: some explorations from a community mental health project.

With an increased interest in and policy commitment to involving service users in the planning and delivery of health service provision, there is a clear need to explore both the rhetoric and realities of what user involvement entails. In the present paper, by drawing upon an evaluation of a community-based exercise facility for people with mental health problems, the authors explore ways in which the reality of user involvement is subject to a range of configurations within health services. The paper describes a piece of qualitative research that was undertaken within a participatory framework to explore the nature of user involvement within the facility. The data have been analysed using a grounded theory approach to provide insights into: the organisational context in which user involvement takes place; factors which encourage meaningful participation on the part of service users; perceived barriers to user involvement; and issues of sustainability and continuity. This research approach has enabled the authors to explore the views and experiences of users, service providers and referral agencies in relation to the nature and potential for user involvement. The findings illustrate ways in which user involvement may take place under both flexible and formal arrangements across a variety of activities. The present paper provides an account of some of the meanings and experiences of what 'successful' user participation may involve and the conditions which underpin 'success'. The authors conclude that successful and meaningful user involvement should enable and support users to recognise their existing skills, and to develop new ones, at a pace that suits their particular circumstances and personal resources. This process may require adaptation not only by organisations, but also by service providers and non-involved users.

Community Mental Health Services↗

PubMed2000

Mental health service user involvement in nurse education: exploring the issues.

This paper reports on findings and issues arising from a study designed to promote mental health service users' involvement in a preregistration nursing curriculum. Users' views about the knowledge, skills and attributes required by mental health nurses were explored to inform the curriculum design. Strategies that would facilitate long term, active user involvement in the design and delivery of the curriculum were also explored. Findings are presented with concurrent discussion of issues arising from the research process in relation to user involvement in education. The issue of 'conflict' explores findings relating to users' views of a 'good' mental health nurse and inherent conflicts between user and professional views are highlighted. The representativeness of the research participants is explored and debated in relation to service user involvement in nurse education. Finally, the concepts of 'involvement' and 'tokenism' are discussed and recommendations made about how active user involvement in nurse education can be achieved.

Curriculum↗

PubMed2002

Groin exploration for nonpalpable testes: laparoscopic approach.

PURPOSE: Diagnostic laparoscopy (DL) is the technique of choice for exploration of nonpalpable testes (NPT). Nevertheless, groin exploration is necessary to evaluate the cord and gonadal structures entering the internal ring. This retrospective analysis evaluates our hypothesis that hypoplastic cord structures entering the internal ring predicts absence of a viable testicle and a laparoscopic groin exploration in these cases can reduce the number of unnecessarily performed open groin exploration (OGE). MATERIALS: A retrospective review was performed of 23 boys with 26 NPTs who were operated on from June 1998 to October 2000 to evaluate our protocol for NPT using DL and OGE. RESULTS: Of 26 NPTs in 23 boys, 3 bilateral intraabdominal testis were detected (2 Fowler Stephens; 1 standard orchidopexy). Twenty cord structures entered the internal ring. Three appeared normal at DL with a viable testis followed by an orchidopexy. Seventeen were hypoplastic without patent processus. During LGE no viable testis was detected: blind-ending cords, no biopsy (n = 4); testicular regression syndromes (n = 3), early fetal regression (n = 6), no residual testicular structures (n = 4). CONCLUSIONS: This experience confirms the authors' hypothesis and criteria for LGE in all cases. The authors conclude that LGE is a helpful tool in the diagnostic workup of NPT to avoid unnecessary OGE and is a further step in the minimally invasive approach to all kinds of findings of NPT.

Adolescent↗

PubMed2002

[Management of common bile duct stones--Results of a nationwide survey with analysis of 8 433 common bile duct explorations in Germany].

BACKGROUND: Aim of this study was the evaluation of the management of choledocholithiasis and outcome of laparoscopic as well as open cholecystectomy in Germany. METHODS: A written questionnaire was sent to 449 randomly selected German surgeons annually from 1991 to 1994 and additionally to all German university hospitals until 1998. RESULTS: A total of 98 482 operations for gallstone disease including 86 485 cholecystectomies (non-university hospitals 1991-1993: n = 60 246, university hospitals 1991-1996: n = 26 239) and 8 433 common bile duct (CBD) explorations (non-university hospitals: n = 6 919, university hospitals: n = 1 514) with or without cholecystectomy were reported. The overall complication rate for CBD explorations was 13.2 % (non-university hospitals) and 15.1 % (university hospitals), the overall hospital mortality rate was 0.64 % (non-university hospitals) and 0.58 % (university hospitals, n. s.). When choledocholithiasis was suspected, in 1998 all university hospitals used a two-stage management with preoperative ERC. In case of diagnosed isolated choledocholithiasis 93 % usually chose an endoscopic approach. When simultaneous cholecysto-choledocholithiasis was diagnosed preoperatively 86 % of the university hospitals used a two-stage management with preoperative ERC and stone extraction and secondary cholecystectomy (1991: 45 %). The percentage of CBD explorations decreased continuously from 7.4 % in 1991 to 3.8 % in 1996 (p < 0.01). CONCLUSION: These results allow for the estimation of frequency and overall risks in surgical therapy of CBD stones. At the moment, laparoscopic CBD exploration does not play a significant role in Germany. Data show a trend to the two-stage "therapeutical splitting" with lower complication rates.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1999

Chest re-exploration for complications after lung surgery.

BACKGROUND: Review of the most recent chest re-explorations for lung surgery complications may show methods by which risks can effectively be reduced. METHODS: The data on rethoracotomies following lung surgery over the past 14 years in our department were retrospectively reviewed. The indication, the type of operation, the outcome, and various factors influencing the postoperative mortality were analyzed. From 1983 to 1996, 1960 patients underwent primary thoracotomies for various lung diseases. Among these, 73 (3.7%) patients required re-exploration for various postoperative complications. RESULTS: Mean age was 56.8 years (15-80 years). There were 66 (90.4%) men and 7 (9.6%) women. The most common indication for rethoracotomy was hemorrhage in 38 (52%) patients. The source of bleeding was a mediastinal and/or bronchial blood vessel in 8 patients and an intercostal blood vessel in 6 patients. Six patients had to be reoperated because of hemorrhage from a major artery of the hilus. In 14 cases the postoperative hemothorax occurred without evident surgical origin. Further indications for rethoracotomy were bronchopleural fistula (BPF) in 13 (17.8%) patients, and persistent parenchymal leak in 8 (10.9%) patients. There were 8 additional causes distributed among the remaining 14 (19.3%) patients. The overall mortality rate was 17.8% (13/73), with the highest (38.4%) among BPF patients. CONCLUSIONS: Postoperative complications following lung surgery which require rethoracotomy are rare. The most common complication is postoperative bleeding. This is followed by bronchial stump insufficiency which is associated with the highest mortality and morbidity. Our experience shows that the need for re-exploration can hardly be reduced but the indication for re-exploration should be established as early as possible to avoid late complications.

Adolescent↗

PubMed1995

Routine bilateral exploration for inguinal hernia in infancy and childhood.

Whether to explore the contralateral side is a real question regarding the management of unilateral inguinal hernias in infants and children. The surgeon can easier make a decision if he knows the true incidence and prevalence of the bilateral involvement in different ages. During the years 1982 to 1991 the authors could find 138 contralateral hernias developed after unilateral herniorrhaphy in 2554 children (5.4%). Fifty-five percent of these children (76 patients) were younger than 1 year of age, 74% of them (102 patients) were younger than 3 years of age at the time of the initial repair. The interval between the operations was less than 1 year in 54% of the cases. To get more precise data, we explored 148 children younger than 3 years of age bilaterally during 1992. The result was positive in 104 cases (70.3%). The bilateral involvement was most frequent under the first 6 months of life (83.5%), then it dropped gradually. We found a patent processus vaginalis on the asymptomatic side in 74.3% of girls and in 61.1% of boys. The overall contralateral involvement of unilateral hernias was 64.8%, independently of which side the hernia had appeared on. The patent processus vaginalis can be regarded as a precursor of indirect hernias, so the contralateral exploration can prevent the development of a later hernia. The authors conclude that bilateral exploration is mainly justified during infancy, but in case of girls they suggested applying it until three years of age.

Child↗

PubMed2003

Clinical outcomes and fiscal consequences of bilateral neck exploration for primary idiopathic hyperparathyroidism without preoperative radionuclide imaging or minimally invasive techniques.

BACKGROUND: Radionuclide imaging-directed, minimally invasive parathyroid operation is promoted in the surgical literature and public domain as the fastest, most successful, and cheapest means of treating primary idiopathic hyperparathyroidism. The validity of these claims is unproven. This study reviews the treatment outcome results of a large series of patients treated with standard parathyroid operation without preoperative localization studies. Cost comparisons are made between this series and previous reports of selected patients in whom preoperative radionuclide imaging preceded minimally invasive parathyroid operation. METHODS: Diagnosis, treatment, and outcome data for 688 consecutive patients undergoing first neck exploration for primary idiopathic hyperparathyroidism were prospectively collected. All patients in our series underwent standard bilateral neck exploration without preoperative localization studies. Intraoperative methylene blue was used to aid identification of all parathyroid glands. Surgical findings, pathological diagnosis, operative time, length-of-stay, and treatment success data were collected. Cost data were calculated for our series using the identical calculations used in previous reports. Our outcome and calculated cost data were compared with previous reports by centers advocating scan-directed, minimally invasive parathyroid operation. RESULTS: Of 2,752 predicted total glands, 2,520 (91.6%) were identified using standard neck exploration without radionuclide localization studies. Single adenoma, with at least 1 normal gland, was found in 542 patients (78.8%), with 8 in a fifth gland. Multiple-gland hyperplasia was identified in 98 patients (14.2%) and of these 22 (3.2%) were double adenomas. Ten patients had parathyroid carcinoma (1.5%), and all received definitive surgical treatment during the primary operation. Cure rates were assessed by measurement of normal serum calcium and parathyroid hormone levels at 3 and 12 months after operation, and were 97.7% in our series. Mean operating time for the entire series was 65 minutes, decreased to 35 minutes in patients with single adenomas, and mean recovery room time was 30 minutes. Mean total costs for patients undergoing standard exploration for single adenoma was US dollars 1,107, and increased to US dollars 1,243 when patients with multigland disease, hyperplasia, or malignancy were included. CONCLUSIONS: Our series demonstrates operative times and treatment outcomes with costs that are approximately one-third less than those for scan-directed, minimally invasive operation for primary idiopathic hyperparathyroidism. Thus, claims that scan-directed parathyroid operation is the cheapest, fastest, and most successful means of treatment are not supported by these data.

Adenoma↗

PubMed1993

Toward a computational model of constraint-driven exploration and haptic object identification.

A conceptual model of the human haptic system in relation to object identification is presented. The model encompasses major architectural elements including representations of haptically accessible object properties and exploratory procedures (EPs)--dedicated movement patterns that are specialized to extract particular properties. These architectural units are related in processing-specific ways. Properties are associated with exploratory procedures in keeping with the extent to which a given procedure delivers information about a given property. The EPs are associated with one another in keeping with their compatibility, as determined by parameters of motor execution and interactions with the object and the workspace. The resulting architecture is treated as a system of constraints which guide the exploration of an object during the course of identification. The selection of the next step in a sequence of exploration requires that constraints be optimally satisfied. A network approach to constraint satisfaction is implemented and shown to account for a number of previous empirical results concerning the time course of exploration, object classification speed, and incidental learning about object properties. This system has potential applications for robotic haptic exploration.

Attention↗

PubMed1993

Hand movements and hemispheric specialization in dichhaptic explorations.

Dichhaptic testing has been widely used to assess lateralization in tactile processing. The rationale of dichhaptic testing is that simultaneous exploration of two objects enhances competition between relevant cortical areas in the right and left hemispheres. The synchronization of hand movements in a dichhaptic situation was investigated to determine whether both hands explore the two shapes simultaneously. Fourteen men were tested with the aid of a dichhaptic intermodal task. Tactile stimuli were composite shapes and the activity of each hand was assessed through analysis of hand contacts on each part of the shape. Only 20% of the total exploration time was devoted to simultaneous investigation of the two shapes. In addition, it was found that (i) the recognition accuracy was greater when the target shape was explored by the left hand compared with the right, and (ii) the left hand touched a greater number of parts of the stimuli than the right. Overall, comparison of the present data with those from a previous, monohaptic, task with the same stimuli suggests an advantage of dichhaptic over monohaptic testing to demonstrate laterality differences in accuracy of recognition. However, it is suggested that this advantage is due to cognitive factors rather than to competition between homologous cortical areas.

Adult↗

PubMed1994

Tactual object exploration and recognition in blind and sighted children.

Development of the haptic system was evaluated by examining object exploration and recognition in sighted children between the ages of 3 and 8 years. To determine the importance of visual experience for these abilities, the performance of seven congenitally blind children was compared with that of sighted peers matched for age and gender. Performance was evaluated in terms of the speed and correctness of object identification, thoroughness of exploration of object parts, representation of the global form versus local parts of objects, and the possible role of critical parts in object identification. Four types of common objects were presented: normal-sized, miniaturized small, miniaturized large, and oversized objects. All subjects were required to manipulate and identify these objects haptically, without the aid of vision. Results revealed the emergence of a developmental pattern in all performance measures for sighted children. Older sighted children were not only able to recognize more objects and to do so more quickly, but also were more thorough in their exploration patterns. With increasing age, children appear to change their representation of objects from one based predominantly on global shape to one that incorporates a balance of global shape and specific local parts. In agreement with this, critical parts also played a role in object identification, particularly in older children. Blind and sighted children did not differ in any performance measures, which suggests that previous visual experiences do not determine tactile exploration strategies and are not essential for haptic object recognition.

Attention↗

PubMed2002

Recombinatoric exploration of novel folded structures: a heteropolymer-based model of protein evolutionary landscapes.

The role of recombination in evolution is compared with that of point mutations (substitutions) in the context of a simple, polymer physics-based model mapping between sequence (genotype) and conformational (phenotype) spaces. Crossovers and point mutations of lattice chains with a hydrophobic polar code are investigated. Sequences encoding for a single ground-state conformation are considered viable and used as model proteins. Point mutations lead to diffusive walks on the evolutionary landscape, whereas crossovers can "tunnel" through barriers of diminished fitness. The degree to which crossovers allow for more efficient sequence and structural exploration depends on the relative rates of point mutations versus that of crossovers and the dispersion in fitness that characterizes the ruggedness of the evolutionary landscape. The probability that a crossover between a pair of viable sequences results in viable sequences is an order of magnitude higher than random, implying that a sequence's overall propensity to encode uniquely is embodied partially in local signals. Consistent with this observation, certain hydrophobicity patterns are significantly more favored than others among fragments (i.e., subsequences) of sequences that encode uniquely, and examples reminiscent of autonomous folding units in real proteins are found. The number of structures explored by both crossovers and point mutations is always substantially larger than that via point mutations alone, but the corresponding numbers of sequences explored can be comparable when the evolutionary landscape is rugged. Efficient structural exploration requires intermediate nonextreme ratios between point-mutation and crossover rates.

Biophysical Phenomena↗

PubMed2005

Surface exploration using laparoscopic surgical instruments: the perception of surface roughness.

During laparoscopic surgery video images are used to guide the movements of the hand and instruments, and objects in the operating field often obscure these images. Thus, surgeons often rely heavily on tactile information (sense of touch) to help guide their movements. It is important to understand how tactile perception is affected when using laparoscopic instruments, since many surgical judgements are based on how a tissue 'feels' to the surgeon, particularly in situations where visual inputs are degraded. Twelve naïve participants used either their index finger or a laparoscopic instrument to explore sandpaper surfaces of various grits (60, 100, 150 and 220). These movements were generated with either vision or no vision. Participants were asked to estimate the roughness of the surfaces they explored. The normal and tangential forces of either the finger or instrument on the sandpaper surfaces were measured. Results showed that participants were able to judge the roughness of the sandpaper surfaces when using both the finger and the instrument. However, post hoc comparisons showed that perceptual judgements of surface texture were altered in the no vision condition compared to the vision condition. This was also the case when using the instrument, compared to the judgements provided when exploring with the finger. This highlights the importance of the completeness of the video images during laparoscopic surgery. More normal and tangential force was used when exploring the surfaces with the finger as opposed to the instrument. This was probably an attempt to increase the contact area of the fingertip to maximize tactile input. With the instrument, texture was probably sensed through vibrations of the instrument in the hand. Applications of the findings lie in the field of laparoscopic surgery simulation techniques and tactile perception.

Adult↗