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Cureus Feb 2023Ovarian cancer is a feared diagnosis for women and clinicians alike. Ovarian mucinous adenocarcinoma is a unique subset of ovarian cancer. As a primary tumor, massive...
Ovarian cancer is a feared diagnosis for women and clinicians alike. Ovarian mucinous adenocarcinoma is a unique subset of ovarian cancer. As a primary tumor, massive ovarian masses, and more specifically mucinous adenocarcinomas, have been infrequently reported in the medical literature. Team approaches to massive tumor extirpations are essential, as patients often require the expertise of various subspecialists including, but not limited to, gynecologic-oncologists, general surgeons, and plastic and reconstructive surgeons. Here we present a case of a 71-year-old woman with a massive, incapacitating pelvic mass, later found to be a primary ovarian mucinous adenocarcinoma. Once medically optimized, a multi-service team approach was utilized for tumor extirpation and abdominal wall reconstruction. Involved surgical services included Gynecologic-Oncology, General Surgery, and Plastic and Reconstructive Surgery. Exploratory laparotomy for tumor extirpation, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal stripping, bilateral inguinal lymphadenectomy, and appendectomy was performed. Extensively thin, devascularized, and attenuated abdominal wall fascia that was adherent to the tumor was removed. The abdominal wall defect was reconstructed and reinforced with inlay and overlays of biologic monofilament mesh. Inverted-T of the vertical and horizontal skin components was performed in a tailor-tacking fashion, assuring the maintenance and protection of the abdominal skin flap vascularity through utilizing the Huger Zones of perfusion. Pathology revealed a stage IA grade 2 mucinous adenocarcinoma of the ovary without evidence of metastasis. No adjuvant therapies were required. The tumor's weight was 140 pounds, and its dimensions were 63 x 41 x 40 cm. It is our hope that presenting this experience will raise awareness of this spectrum of diseases and allow for earlier diagnoses and treatments, as well as exemplify the virtues of a team-based approach in the successful extirpation and subsequent reconstruction of the abdominal wall and skin.
PubMed: 37007307
DOI: 10.7759/cureus.35542 -
Bulletin of the Menninger Clinic 1994The 1946 Rorschach protocol of poet Ezra Pound was given blind to three clinical psychologists to see whether interpretations of this historic document would give...
The 1946 Rorschach protocol of poet Ezra Pound was given blind to three clinical psychologists to see whether interpretations of this historic document would give perspective to the controversy that surrounded his hospital commitment as unfit to stand trial for his treasonous radio broadcasts during World War II. The psychologists found greater psychopathology and defect in Pound's functioning than was generally observed when he was originally tested, and they predicted the psychotic-organic depression that occurred after the poet's discharge 12 years later.
Topics: Crime; Famous Persons; History, 20th Century; Hospitalization; Hospitals, Psychiatric; Humans; Neurocognitive Disorders; Poetry as Topic; Rorschach Test; United States; Warfare
PubMed: 7920371
DOI: No ID Found -
Journal of Food Science and Technology Sep 2021The optimum formulation of a low carb pound cake was determined using alternative ingredients to replace the main sources of digestible carbohydrates in the standard...
UNLABELLED
The optimum formulation of a low carb pound cake was determined using alternative ingredients to replace the main sources of digestible carbohydrates in the standard formulation. Surface response methodology was a useful tool in the investigation of the use of custard apple puree (CAP), fructooligosaccharides (FOS) and soy protein hydrolysate (SPH) as partial or total replacers for wheat flour, sucrose, and powdered whole milk, respectively. The quality of pound cakes was assessed by measuring the batter and cake properties. The percentage of ingredients substitution affected the specific gravity of the batter, cakes specific volume, crumb firmness, instrumental color parameters (*, *, *) and number and circularity of alveoli from pound cake slices. The model equations developed can be used for predicting the quality of the pound cake. The optimum formulation of low carb pound cake with 40.98% of CAP, 94.94% of FOS and 100% of SPH, in replacement of wheat flour, sucrose and powdered whole milk, respectively, has a 93.70% of desirability. A reduction of 60.67% in digestible carbohydrates was reached. The main reduction occurs in the starch content due to the wheat flour replacement and the non-reducing sugar content due to the sucrose partial substitution. The low carb pound cake had a moderate glycemic index (60.08%), a low glycemic load (4.69%) and accepted by the judges through sensory analysis, with an acceptability index of 72.08 ± 3.97%.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13197-021-05155-9.
PubMed: 34366480
DOI: 10.1007/s13197-021-05155-9 -
Population Concern News 1994
Topics: Ambulatory Care Facilities; Asia; Contraception; Delivery of Health Care; Developed Countries; Developing Countries; Economics; Europe; Family Planning Services; Financial Management; Health; Health Facilities; Health Planning; Health Services Accessibility; International Cooperation; Organizations; Pakistan; United Kingdom
PubMed: 12288412
DOI: No ID Found -
Family Planning Today 1995
Topics: Contraception; Cost-Benefit Analysis; Delivery of Health Care; Developed Countries; Europe; Evaluation Studies as Topic; Family Planning Policy; Family Planning Services; Government; Health; Health Personnel; Health Planning; Health Services; Health Services Accessibility; National Health Programs; Physicians; Politics; Program Evaluation; Public Policy; United Kingdom
PubMed: 12319467
DOI: No ID Found -
Paediatrics & Child Health Jul 2018
PubMed: 30039810
DOI: 10.1093/pch/pxy065 -
The Journal of Prosthetic Dentistry Sep 1970
Topics: Denture, Complete, Immediate; Denture, Partial, Temporary; Health Education, Dental; Humans; Patient Care Planning; Postoperative Care; Surgery, Oral; Wound Healing
PubMed: 5270666
DOI: 10.1016/0022-3913(70)90021-1 -
Narrative Inquiry in Bioethics 2018Obesity in the United States has been declared both a disease and an epidemic. Physicians have thus been identified as the "experts" in managing weight loss, but they...
Obesity in the United States has been declared both a disease and an epidemic. Physicians have thus been identified as the "experts" in managing weight loss, but they have few effective solutions to recommend except bariatric surgery. Most physicians and medical facilities are unprepared to manage the complex medical needs of obese patients, and most families are unprepared to manage the dietary issues in helping a family member lose weight, much less the physical, psychological, and interpersonal issues that surface. This case explores the medical, ethical, and communication challenges that arose in the case of a patient who weighed 800 pounds.
Topics: Bariatric Surgery; Body Weight; Bullying; Delivery of Health Care; Diet; Domestic Violence; Family; Humans; Interpersonal Relations; Male; Middle Aged; Mood Disorders; Obesity, Morbid; Patient Transfer; Weight Loss
PubMed: 30595593
DOI: 10.1353/nib.2018.0075 -
Health Technology Assessment... 2000PROPOSED SERVICE: The service proposed is the use of implantable cardioverter defibrillators (ICDs) in the management of risk factors leading to sudden cardiac death... (Comparative Study)
Comparative Study Review
UNLABELLED
PROPOSED SERVICE: The service proposed is the use of implantable cardioverter defibrillators (ICDs) in the management of risk factors leading to sudden cardiac death (SCD). ICDs are similar in size to a pacemaker and are intended to prevent death due to life-threatening ventricular tachyarrhythmias.
EPIDEMIOLOGY AND BACKGROUND
SCD occurs in approximately 100,000 people annually in the UK and is usually due to ventricular tachyarrhythmia. Increasing numbers of people are surviving a first episode of ventricular tachyarrhythmia and are at high risk of further episodes. Standard treatments for those at high risk have been anti-arrhythmic drugs, catheter ablation or surgery and, increasingly, vasodilating beta-blockers.
METHODS
Electronic databases were searched for the period 1980-99. In addition, bibliographies of related papers were assessed for relevant studies, and experts were contacted to identify additional published and unpublished references. Studies were included if they were systematic reviews, meta-analyses or randomised controlled trials (RCTs) comparing ICDs with conventional therapy in people at high risk of SCD.
NUMBER AND QUALITY OF STUDIES AND DIRECTION OF EVIDENCE
Seven RCTs on effectiveness the majority of which were of good quality, eight cost-effectiveness analyses most of which were older studies and based on non-UK data, and two good-quality literature reviews one of which was a critical appraisal of the literature of effectiveness and cost-effectiveness of ICD therapy, and the other a review of the cost-effectiveness of ICD therapy. These showed changes in absolute risk of total mortality ranging from an increase of 1.7% to a reduction of 22.8% (relative risk reductions of -7% to +54%).
SUMMARY OF BENEFITS
Estimated benefits from RCT data are 0.23-0.8 additional years of life with ICD therapy compared with anti-arrhythmic drug therapy.
COSTS
Unit cost of ICDs (based on 1999/2000 prices), ranges from pound 12,500 to pound 22,000. Total discounted costs for 3 years range from pound 20,000 to pound 29,000. COST-EFFECTIVENESS: Cost-effectiveness estimates in the literature identified range from $11,000 to $146,000 per life-year saved. Using UK cost data from three hospitals and trial survival data from one RCT, the estimate of cost-effectiveness from this review ranges between pound 20,250 and pound 87,000 per life-year saved. COST-UTILITY: Cost per quality-adjusted life-year is estimated by the authors of this review at pound 21,300 to pound 108,800 (using survival data from one trial and quality-of-life indices derived from clinical opinion). These figures remain speculative until quality-of-life data from ongoing trials are available to inform future UK cost-effectiveness/utility analyses.
IMPLICATIONS
If implemented for indications supported by evidence from RCTs, ICDs may cost the NHS in excess of pound 24 million per annum.
FUTURE RESEARCH
Future research should include the use of British Pacing and Electrophysiological Group registries to assess the use of different types of ICD and current service provision.
Topics: Anti-Arrhythmia Agents; Cost-Benefit Analysis; Death, Sudden, Cardiac; Defibrillators, Implantable; Health Care Costs; Humans; Quality-Adjusted Life Years; Risk Factors; Tachycardia, Ventricular
PubMed: 11086270
DOI: No ID Found -
International Wound Journal Feb 2009Judicious resource allocation to maximise benefits is essential to health care decision-making, particularly with increasingly expensive treatments and rising... (Review)
Review
Judicious resource allocation to maximise benefits is essential to health care decision-making, particularly with increasingly expensive treatments and rising populations. Accurate wound debridement is important, and while many methods exist, surgical debridement is currently the gold standard with material costs at approximately pound 140. Versajet, a hydrosurgical device, is suggested by some to have facilitated a paradigm shift in wound management by allowing debridement of undesirable tissue while accurately preserving viable structures. Its proponents claim that it minimises surgical duration, length of hospital admission, improves wound healing and may be deployed at the bedside or in the community. Consoles and single-use hand-units cost pound 6000- pound 7000 and pound 220- pound 240, respectively. Some propose that hydrosurgery may provide an efficacious, efficient and cost-effective alterative to surgical debridement. However, the evidence available is largely based on expert opinion. Methodological flaws of such descriptive studies include the lack of control groups, selection bias and lack of blinding. Hence, these claims need to be interpreted cautiously. This opinion review examines the available evidence as to whether Versajet hydrosurgery provides quality and cost-effective care.
Topics: Cost-Benefit Analysis; Debridement; Equipment Design; Humans; Quality of Health Care; Wounds and Injuries
PubMed: 19291112
DOI: 10.1111/j.1742-481X.2008.00560.x