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PubMed2006

Procedural justice and the hedonic principle: how approach versus avoidance motivation influences the psychology of voice.

The authors investigate the relation between the hedonic principle (people's motivations to approach pleasure and to avoid pain) and procedural justice. They explore whether approach or avoidance motivation increases the effect that people feel they were treated more fairly following procedures that do versus do not allow them an opportunity to voice their opinion. Experiments 1 and 2 reveal that these procedures influence procedural justice judgments more strongly when people conduct approach motor action (arm flexion) than when they conduct avoidance motor action (arm extension). Experiment 3 indicates that individual-difference measures of participants' approach motivations predicted procedural justice judgments following voice versus no-voice procedures. The authors conclude that people's motivational orientations stimulate their fairness-based reactions to voice procedures.

Adolescent↗
PubMed2003

An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation.

The role of allogeneic bone marrow transplantation in lymphoma remains uncertain. We have analyzed 1185 allogeneic transplants for lymphoma reported to the EBMT registry between 1982 and 1998 and compared the results with those of 14687 autologous procedures performed over the same period. Patients receiving allogeneic transplants were subdivided according to histology: low-grade non-Hodgkin's lymphoma (NHL) 231 patients; intermediate-grade NHL 147 patients; high-grade NHL 255 patients; lymphoblastic NHL 314 patients; Burkitt's lymphoma 71 patients; and Hodgkin's disease 167 patients. These patients received allogeneic transplants as their first transplant procedure. Actuarial overall survival (OS) at 4 years from transplantation was: low-grade NHL 51.1%; intermediate-grade NHL 38.3%; high-grade NHL 41.2%; lymphoblastic lymphoma 42.0% years; Burkitt's lymphoma 37.1%; and Hodgkin's disease 24.7% years. These outcomes are relatively poor because of the high procedure-related mortality associated with these procedures, particularly in patients with Hodgkin's disease (51.7% actuarial procedure-related mortality at 4 years). Multivariate analysis showed that for all lymphomas apart from Hodgkin's disease, status at transplantation significantly affected outcome. A matched analysis was performed: for all categories of lymphoma, OS was better for autologous than for allogeneic transplantation. Relapse rate was better in the allogeneic group for low-, intermediate- and high-grade, and lymphoblastic NHL. It was equivalent for Burkitt's lymphoma and worse in the allogeneic group for Hodgkin's disease. Allogeneic transplantation appears to be superior to autologous procedures in terms of producing a lower relapse rate. The toxicity of allogeneic procedures must however be reduced before this translates into an improvement in OS.

Adolescent↗
PubMed1986

Comparison of pure-tone audibility thresholds obtained with audiological and two-interval forced-choice procedures.

Audibility thresholds were measured at 500 and 4000 Hz with a standard clinical procedure and a two-interval, forced-choice (2IFC) adaptive procedure for 72 normal-hearing and hearing-impaired listeners, age 17 to 83. Psychometric functions were obtained for clinical, 2IFC, and Yes-No procedures. A measure of response bias was obtained from the Yes-No procedure. The 2IFC adaptive thresholds were 6.5 dB lower than audiological thresholds. The psychometric functions for the forced-choice procedures were generally shallower than those for the clinical procedure and were shifted to lower sound pressure levels. Response bias played a small role at best in accounting for the magnitude of the difference in threshold estimated by the adaptive and clinical procedures or for the differences among the psychometric functions.

Adolescent↗
PubMed2001

Cerebellar contribution to spatial event processing: involvement in procedural and working memory components.

Spatial function is one of the cognitive functions altered in the presence of cerebellar lesions. We investigated the cerebellar contribution to the acquisition of spatial procedural and working memory components by means of a radial maze. To establish whether a cerebellar lesion would cause a deficit in solving the radial maze, a first experiment was carried out by using a full-baited maze procedure in different experimental groups, with or without cerebellar lesion and with or without pretraining. Non-pretrained hemicerebellectomized (HCbed) animals exhibited impaired performances in all (motor, spatial and procedural) task aspects. Pre-trained HCbed animals performed similarly to control animals in the task aspects linked to the processing of spatial and procedural factors. To distinguish procedural from working memory components, a forced-choice paradigm of the radial maze was used in the second experiment. Non-pretrained HCbed rats continued to make a lot of errors and show severe perseverative tendencies, already observed in the first experiment, supporting a specific cerebellar role in acquiring new behaviours and in modifying them in relation to the context. Interestingly, hindered from putting the acquired explorative patterns into action and compelled to use only working memory abilities, the pretrained HCbed group exhibited a dramatic worsening of performance. In conclusion, the present findings demonstrate that cerebellar damage induces a specific behaviour in radial maze tasks, characterized by an inflexible use of the procedures (if indeed any procedure was acquired before the lesion) and by a severe impairment in working memory processes.

Animals↗
PubMed2003

A comparison of the International Standards Organisation reference method for the detection of coliforms and Escherichia coli in water with a defined substrate procedure.

AIMS: This study investigated the use of the International Standards Organisation (ISO) procedure for the comparison of microbiological methods. Using this procedure the ISO reference procedure for the detection of coliforms and Escherichia coli in water was compared with a defined substrate method (ColilertTM). METHODS AND RESULTS: A total of 20 laboratories from 13 European countries compared the use of Colilert/Quanti-TrayTM, a quantitative defined substrate test (DST) for the presence of coliforms and E. coli with the ISO reference procedure, which utilizes tergitol-TTC medium. Results of the study showed that DST detected significantly more coliforms and E. coli than did the reference procedure. In the case of E. coli the recoveries were also higher when using DST and the difference seen was statistically significant. The confirmation rate obtained when using the DST product suggested that no confirmation of wells positive for E. coli was necessary during routine use. CONCLUSIONS: Colilert is a suitable alternative to the ISO reference procedure for the detection of coliforms and E. coli in water. The methods used during the comparison study indicated that confirmation of all colonies/positive wells led to the most accurate information and it is recommended that for future comparison studies this should become standard practice. Confirmation of a small proportion of colonies led to misleading conclusions and should be avoided when comparing microbiological methods. SIGNIFICANCE AND IMPACT OF STUDY: It has been demonstrated that the ISO reference procedure fails to detect a significant proportion of coliforms and E. coli in drinking water. Colilert/QuantiTrayTM is a more suitable alternative.

Bacteriological Techniques↗
PubMed2001

A new CentriSwim procedure to increase the recovery of motile spermatozoa.

A prospectively controlled in vitro study was performed to compare sperm concentration, sperm motility and progressive sperm motility recovered following the standard swim-up procedure and a new CentriSwim procedure. The CentriSwim procedure involves creating a centrifugal force to counteract the force of gravity during sperm swim-up procedure. Two aliquots of semen from 12 normozoospermic ejaculates and 12 laboratory-induced oligoasthenozoospermic specimens were diluted, centrifuged, and 1.0 ml of media layered over the sperm pellet. One aliquant was processed by standard swim-up technique. The other aliquant was processed by CentriSwim procedure involving centrifugation at 200 rpm on a 2-cm radius upward-directing arm, at an angle of 60 degrees for 10 min, creating roughly 0.8 g centrifugal force at room temperature (22-24 degrees C) to counteract the force of gravity. The numbers of spermatozoa recovered from the upper 0.5 ml of the medium following CentriSwim from the normozoospermic ejaculates and laboratory-induced oligoasthenozoospermic specimens were significantly higher than following standard swim-up procedure. No statistical differences in the recovery of percentage sperm motility and progressive sperm motility between the two techniques were observed. In conclusion, the CentriSwim procedure yields higher numbers of motile spermatozoa than the standard swim-up technique.

Cell Separation↗
PubMed1997

Do patient preferences contribute to racial differences in cardiovascular procedure use?

OBJECTIVE: To determine whether patient preferences for the use of coronary revascularization procedures differ between white and black Americans. DESIGN: Cross-sectional survey. SETTING: Tertiary care Department of Veterans Affairs hospital. PATIENTS: Outpatients with and without known coronary artery disease were interviewed while awaiting appointments (n = 272). Inpatients awaiting catheterization were approached the day before the scheduled procedure (n = 80). Overall, 118 blacks and 234 whites were included in the study. MEASUREMENTS AND MAIN RESULTS: Patient responses to questions regarding (1) willingness to undergo angioplasty or coronary artery bypass surgery if recommended by their physician and (2) whether they would elect bypass surgery if they were in either of two hypothetical scenarios, one in which bypass surgery would improve symptoms but not survival and one in which it would improve both symptoms and survival. Blacks were less likely to say they would undergo revascularization procedures than whites. However, questions dealing with familiarity with the procedure were much stronger predictors of a positive attitude toward the procedure use. Patients who were not working or over 65 years of age were also less interested in procedure use. In multivariable analysis race was not a significant predictor of attitudes toward revascularization except for angioplasty recommended by their physician. CONCLUSIONS: Racial differences in revascularization rates may be due in part to differences in patient preferences. However, preferences were more closely related to questions assessing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed revascularization. Further research should address this issue in patients contemplating actual revascularization.

Adult↗
PubMed2003

Protein composition and activation markers in plasma collected by three apheresis procedures.

BACKGROUND: Scientific and technical advances made in transfusion medicine sustain the need for more comprehensive understanding of the impact of collection procedures on the quality of plasma for fractionation and for transfusion. This prospective work evaluated protein composition and markers of activation in plasma donations collected with three different automatic collection procedures (performed on Haemonetics machines), including a new procedure using a high-separation core-molded bowl. STUDY DESIGN AND METHODS: A total of 90 collection procedures have been performed from a population of 37 donors, under comprehensively standardized conditions. Plasma aliquots were taken from the plasma units within 30 minutes of the end of the collection procedures and immediately frozen at -70 degrees C. Content in an extended range of proteins and of markers of activation of the coagulation and fibrinolytic systems has been measured using standard in vitro testing methods. RESULTS: Plasma donations had normal mean total protein, IgG, IgM, and fibrinogen content. The mean levels in coagulation FV, FVII, FVIII, and FXI and in antithrombin were above the standard international requirements. There was no sign of activation of the hemostasis system, as assessed by activated FVII, thrombin antithrombin complex, Prothrombin fragment 1+2, and D-dimers. Activated complement component C3 and C5 were low. CONCLUSION: Data indicates the good and consistent protein composition of plasma obtained by those automatic apheresis procedures. In particular, the new high-separation core procedure yields a high-quality plasma meeting requirements for transfusion and fractionation.

Adult↗
PubMed1998

Use of coronary angiography and revascularization procedures following acute myocardial infarction. A European perspective.

AIMS: There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions concerning the impact of the high rate of these cardiac procedures. METHODS AND RESULTS: A population-based patient sampling approach was utilized to identify routine practice in representative samples from 11 European countries. Data were collected retrospectively on treatment in the 6 months following acute myocardial infarction (n=2807). There was wide variation in utilization of coronary angiography and revascularization procedures. Even after restricting the analysis to patients <65 years (n=1262), there remained a 6 13 fold variation in the use of these procedures. A decreased likelihood of undergoing these procedures was associated with older age. In addition, there was an independent and negative association between female sex and utilization of coronary angiography and coronary artery bypass grafting (CABG). CONCLUSION: The effect on patient outcome of the observed variation in use of these procedures is not known but has important cost and resource implications for the health services. Outcome research is needed to define patient selection criteria and to measure the cost-utility of different angiography and revascularization rates.

Adult↗
PubMed2000

Long-term follow-up of redo pull-through procedures for Hirschsprung's disease: efficacy of the endorectal pull-through.

BACKGROUND/PURPOSE: The purpose of this study was to review the authors' 25-year experience with redo pull-through procedures for Hirschsprung's disease including surgical technique and long-term outcome. METHODS: From 1974 to now, over 325 patients with Hirschsprung's disease have been treated at C.S. Mott Children's Hospital. This includes 30 patients referred after an unsuccessful pull-through at another hospital and 2 patients with an unsuccessful pull-through from C.S. Mott. All redo pull-throughs (n = 19) were performed in these patients, and their clinical courses are reviewed. RESULTS: Twelve patients required reoperation secondary to a mechanical problem with their first pull-through. The other 7 patients had evidence of residual segments of dilated colon leading to functional failure of their initial operation including 5 patients with documented aganglionic bowel present at the second pull-through. Ten of the patients requiring reoperation initially had an endorectal pull-through (ERPT), 5 had a Duhamel procedure, 3 had a Swenson procedure, and 1 had a Rehbein procedure. Choice of revision was an ERPT in 8 patients in whom an adequate rectal cuff could be developed. Additional redo procedures included a Duhamel in 8 patients and a Swenson in 3 patients. Follow-up ranges from 3 months to 23 years (mean, 13.8 years). There were no deaths in the series, and 1 patient required a third pull-through. All patients who are not neurologically impaired and are over age 3 are continent except one (94%). Stools per day range from 1 to 10 (mean, 3.2). CONCLUSIONS: Redo pull-through operations for Hirschsprung's disease appear to be as effective as primary procedures in terms of continence and stooling frequency. Distinct from other series, we found an ERPT to be the procedure of choice if an adequate rectal cuff was present.

Adolescent↗
PubMed2002

The EXIT procedure: experience and outcome in 31 cases.

BACKGROUND: The EXIT (ex utero intrapartum treatment) procedure, although initially designed for reversal of tracheal occlusion in fetuses with congenital diaphragmatic hernias (CDH), has been adapted to treat a variety of fetal conditions. METHODS: A retrospective chart review of all consecutive EXIT procedures since 1996 was conducted. RESULTS: Thirty-one women underwent the EXIT procedure, with an average maternal age of 29 years (range, 20 to 38), and average gestational age of 34 weeks (range, 29 to 40). The indication was airway obstruction from fetal neck mass in 13, and reversal of tracheal occlusion from in utero clipping in 13. Singular indications included an EXIT-to-ECMO (extracorporeal membrane oxygenation) procedure for a fetus with CDH and a cardiac defect (n = 1), congenital high airway obstruction syndrome (CHAOS, n = 1), resection of a very large congenital cystic adenomatoid malformation of the lung (CCAM) on uteroplacental bypass (n = 1), unilateral pulmonary agenesis (n = 1), and thoracoomphalopagus conjoined twins. The mean duration on uteroplacental bypass (from uterine incision to umbilical cord clamping) was 30.3 plus minus 14.7 minutes (range, 8 to 66). No fetus experienced hemodynamic instability during uteroplacental bypass as recorded by fetal heart rate (FHR), pulse oximeter, and fetal echocardiography, except for one instance of reversible bradycardia from umbilical cord compression. The mean FHR and fetal saturation were 153.0 plus minus 38.5 beats per minute and 71.2% plus minus 19.9%, respectively. Five fetuses required a tracheostomy. Only 1 death occurred during an EXIT procedure because of inability to secure the airway secondary to extensive involvement by a lymphangioma. The average cord pH and pCO(2) were, respectively, 7.20 plus minus 0.11 and 63.2 plus minus 14.6. Two maternal complications occurred: bleeding from a hysterotomy site and dehiscence of an old hysterotomy scar noticed at a subsequent cesarean section. The average maternal blood loss was 848.3 plus minus 574.1 mL. CONCLUSION: The EXIT procedure was used successfully to ensure uteroplacental gas exchange and fetal hemodynamic stability during a variety of surgical procedures performed to secure the fetal airway or ensure successful transition to postnatal environment.

Adult↗
PubMed2001

Factors influencing access to cardiovascular procedures in patients with chronic kidney disease: race, sex, and insurance.

Blacks and women are less likely to undergo invasive cardiac procedures than whites and men in patients with chronic renal disease. We determined the relationship between ethnic and sex differences in access to cardiac procedures as patients progress to ESRD and acquire Medicare insurance. We performed a cohort study of a nationwide random sample of 4,987 patients who progressed to ESRD in 1986 to 1987 and were followed up for 7 years was used. Data were collected from medical charts and Medicare administrative records. Pre-ESRD, the odds of cardiac procedure use were much lower for white women (adjusted odds 0.67 [95% confidence interval (CI) 0.49-0.92]), black men (adjusted odds 0.32 [95% CI 0.20-0.49]), and black women (adjusted odds 0.30 [95%CI 0.18-0.50]) compared with white men. After initiating dialysis therapy, the ethnic and sex differences decreased with odds of receiving a cardiac procedure compared with white men 0.88 (95% CI 0.63-1.21) for white women, 0.66 (95% CI 0.47-0.92) for black men, and 0.75 (95% CI 0.53-1.08) for black women. Patients uninsured pre-ESRD had the largest increase in procedure rates at follow-up. The wide pre-ESRD disparities in cardiac procedure use between white women, black men, and black women compared with white men narrowed substantially with acquisition of Medicare and entry into comprehensive dialysis care. Health insurance contributed to the narrowing of differences. Procedure use for black men still lagged behind the other groups, suggesting the need for closer examination of health needs in this potentially vulnerable group.

Adult↗
PubMed2002

Ventricular shunting for hydrocephalus in children: patients, procedures, surgeons and institutions in English Canada, 1989-2001.

INTRODUCTION AND PURPOSE: Ventricular shunting remains the principle and most generally applicable method to treat hydrocephalus in children. This paper describes the demographics of this treatment in English Canada during the period of 1989 to March 2001. METHODS: Hospital discharge records were obtained for patients less than 18 years who had a shunt inserted or revised. A database was constructed relating patients and procedures to hospital discharges based on scrambled patient identifiers, year of birth, sex, postal code and diagnoses. OBSERVATIONS: 5,947 patients underwent ventricular shunting procedures for hydrocephalus in this period. 261 surgeons working in 73 institutions provided 12,106 interventions (Shunt insertions: ventriculoperitoneal--5009, ventriculoatrial--119, ventriculopleural--28. Revisions: 6,950). Infection was deemed to have occurred in 1,059 procedures. Over the study period, the median number of procedures performed per surgeon per year was 2, with 75 % of surgeons performing 5 or fewer procedures in children per year. Although many surgeons operated on children throughout the thirteen years of the study, many did not acquire substantive cumulative experience. Overall infection rate was 8.6 %. Surgeon infection rates were greater than or equal to 20 % during the first four years of practice and thereafter they fell to and remained in the 10 % range. The mean shunt survival at 12 months of individual surgeons varied between 50 - 60 %, regardless of the number of years of experience of the surgeon; however, performance variability as measured by the standard deviation of 12 month survival rates for all surgeons, adjusted for years of experience, ranged widely until the fifth year of practice. The average number of procedures per year for treating hospitals was 2 with 75 %, providing 12 or fewer services annually. Over the entire study, 50 % of institutions provided 10 or fewer procedures. The mean institutional infection rate was 11.4 % (SD 23, median--6.0). CONCLUSIONS: Quality monitoring of infection rate and duration of shunt function remains critical as many surgeons and hospitals provide care to children with hydrocephalus infrequently. Variability in infection rates and shunt survival at 12 months are a function of surgeon experience, measured by years in practice. Variability in outcome decreases with increasing surgeon experience.

Adolescent↗
PubMed2003

[The hemiresection-interposition arthroplasty as a salvage procedure for the arthrotically destroyed distal radioulnar joint].

The arthrotically destroyed distal radioulnar joint will lead to painful limitation of forearm rotation. Alternative treatment options are the hemiresection-interposition arthroplasty or the Kapandji-Sauvé procedure. The aim of our study was to evaluate the clinical and functional results following the hemiresection-interposition arthroplasty in non-rheumatoid patients. The most common posttraumatic cause of the arthrosis was the malunited distal radius fracture. In a retrospective study we examined 36 of 51 patients with a mean age of 53 years after an average follow up of 34 months clinically, radiologically and using the DASH questionnaire. The average preoperative pain measured 7.8 on the visual analog scale and was reduced statistically highly significant (p < 0.01) to 3.9. Whilst pronation increased statistically not significantly from a mean of 74 degrees to 76 degrees (p = 0.428), supination improved significantly from 54 degrees to 69 degrees (p - 0.012). The average grip strength increased statistically highly significant (p<0.001) from 40% to 64% compared to the unaffected side. Patients' satisfaction with the result averaged 6.9 on a visual analog scale. Using a modified Mayo-wrist score, six patients were rated to have an excellent, eleven patients a good, ten patients a satisfactory and four patients a poor result. The average DASH score measured 35. In 21 patients radioulnar impingement was found. This appeared to be painful in 14 patients and required revision surgery using the ulnar head prosthesis in five patients. In three patients, secondary ulnar shortening had to be performed due to a remaining painful impaction of the distal ulna against the lunate and triquetrum. Comparing our clinical results with the reported results following the Kapandji-Sauvé procedure from the literature, there was no evident superiority of either of the procedures. There is a need for a functional evaluation following the Kapandji-Sauvé procedure to compare the remaining functional impairment following both procedures. In conclusion both procedures have to be classified salvage procedures and therefore the indication should be limited to the arthrotically destroyed distal radioulnar joint.

Adult↗
PubMed2006

[Modified sacrocolpopexy combined with a Burch procedure for recurrent stress urinary incontinence].

PURPOSE: Surgical procedures for the treatment of stress urinary incontinence (SUI) due to pelvic organ prolapse have specific relapse rates, especially with regard to long-term results. The aim of this study was to investigate the efficacy of a combined surgical technique: sacrocolpopexy combined with a Burch procedure - in particular as an option for previously operated patients. PATIENTS AND METHODS: From 9/2001 to 8/2004, 33 patients (mean age: 65 years) underwent a modified sacrocolpopexy combined with a Burch procedure. Thirty-six (93 %) patients had previous pelvic operations, nineteen (58 %) of them had failure of prior prolapse surgery. All women presented with urinary incontinence, cystocele and vault prolapse. SUI was classified grade II to III in 67 % (n = 22) cases. Grade II - III genital prolapse was associated in 88 % (n = 29) of the patients. They were screened by preoperative video-urodynamics. Surgery consisted of a Burch procedure and modified abdominal sacrocolpopexy. The mean follow-up was 18 months (range: 10 - 30 months). Follow-up investigations included a symptom score and an urogynaecological examination. A subgroup of ten patients had additional postoperative video-urodynamics. RESULTS: In all cases the operative procedure was performed successfully. During the follow-up 73 % (n = 24) of the patients were dry, another 18 % (n = 6) showed significant improvement. The number of diurnal/nocturnal micturitions decreased significantly from 9.4 to 6.9 (p < 0.005) and 2.2 to 1.1 (p < 0.005), respectively. The daily use of incontinence pads, as well as the amount of residual urine, decreased significantly from n = 5.1 to n = 1.1 (p < 0.005) and 60 mL to 6.0 mL (p < 0.005). Postoperative urodynamics showed that the bladder function remained unaffected by the procedure regarding de novo detrusor overactivity. CONCLUSION: After a mean follow-up of 18 months the modified sacrocolpopexy combined with a Burch procedure, as described above, is a promising technique for highly morbid and preoperated patients.

Aged↗
PubMed2006

Nonendoscopic transnasal placement of a wireless capsule for esophageal pH monitoring: feasibility, safety, and efficacy of a manometry-guided procedure.

BACKGROUND AND STUDY AIMS: The aim of the study was to evaluate the safety, feasibility, and efficacy of transnasal placement of the Medtronic Bravo capsule for wireless esophageal pH monitoring. PATIENTS AND METHODS: Forty patients with symptomatic gastroesophageal reflux disease were prospectively evaluated. All patients underwent upper gastrointestinal endoscopy and esophageal manometry. The Bravo capsule was then introduced transnasally and released 5 cm above the upper margin of the lower esophageal sphincter. Serial radiographs were performed weekly until capsule release. RESULTS: Of the 40 patients who were evaluated, 38 (95 %) were eligible to undergo the procedure. Transnasal placement proved impossible in one patient (2.5 %). Overall, a total of 39 procedures were performed in 38 patients (the procedure was repeated in one patient because of accidental intragastric fixation). Esophageal placement was successful in 36/39 procedures (92.3 %). The mean duration of the procedure was 10 minutes (range 5 - 16 minutes). Adverse events were noted in five of the 39 procedures (12.8 %), mild epistaxis in two patients (5.1 %) and pharyngeal irritation in three patients (7.7 %). After the procedure, a slight "foreign body" sensation was reported by 20 of the 36 patients (55.5 %) who had undergone successful esophageal placement; two patients (5.5 %) experienced severe retrosternal pain necessitating endoscopic removal of the capsule. At the end of the study, 34 of the 38 patients (89.5 %) stated that they would be willing to undergo the test again if necessary. CONCLUSIONS: Transnasal placement of the Bravo pH capsule is safe, well tolerated, does not require sedation, and avoids endoscopy and its complications.

Adult↗
PubMed1995

[The physician's duty to inform in interventional radiological therapeutic procedures].

PURPOSE: Interventional radiological procedures have important legal implications. The importance of informing the patient ("informed consent") before such procedures is examined in the light of German legal cases. MATERIAL AND METHODS: The German legal literature is reviewed and recent judgments of the Courts are cited. RESULTS: No all-embracing rules can be obtained from the judgments of the German Courts. Mostly one is dealing with individual judgments which can help in a general sense. The patient should be informed well before elective invasive procedures ("informed consent") and the amount of detailed information which is requested to be given to the patient appears to be increasing. Reversal of this trend in the future is unlikely. DISCUSSION: These judgments are of immediate significance for any radiologist who carries out interventional radiological procedures. In the case of complicated techniques the patient should be informed at the time of admission and a definite date for the procedure should be set. Explanations given on the evening before the procedure are deemed to be too late, unless there are exceptional circumstances. Where new forms of therapy are attempted, the information should be even more detailed. In particular it is necessary to stress the experimental nature of the procedure.

Germany↗
PubMed1999

Nissen fundoplication and Boix-Ochoa antireflux procedure: comparison between two surgical techniques in the treatment of gastroesophageal reflux in children.

Over a period of 19 years an antireflux procedure was performed for gastroesophageal reflux in 59 children. Thirty-two patients underwent Nissen fundoplication and 27 children underwent the Boix-Ochoa antireflux procedure. Six patients died between two and 15 months post surgery of unrelated causes. Follow-up period from six months to 18 years was available in 45 (85%) of the surviving patients. This report summarizes the complications and long-term results with the two surgical procedures and their comparisons. The follow-up evaluation included parental interview and physical examination. Upper GI series and pH monitoring were performed only in children with signs and symptoms of recurrent GER or other post-operative complications. At follow-up with a mean period of 8.7 years following Nissen fundoplication, 87.5% showed good results without any residual symptoms. However, the overall complication rate was as high as 50%. Following the Boix-Ochoa antireflux procedure, 17 (81%) children showed excellent results while four children had recurrent GER. This occurred in two neurologically impaired children and two patients following esophageal atresia repair. No other post-operative complications were encountered with the Boix-Ochoa antireflux procedure. In our experience, the Boix-Ochoa antireflux procedure should be the procedure of choice in the surgical treatment of GER in otherwise normal children while the Nissen fundoplication is preferable in neurologically impaired children and in patients with GER following esophageal atresia repair.

Female↗