Adherence to follow‐up recommendations for dogs with apocrine gland anal sac adenocarcinoma: A multicentre retrospective study
Aidan R. ChambersOwen T. SkinnerMegan A. MickelsonAriel N. SchlagJ. Ryan ButlerMandy L. WallaceAshley L. MoyerArathi VinayakNina SamuelKatie C. KennedyKatherine E. OakesValery F. ScharfLindsay A. ParkerBrandan G. Wustefeld‐Janssens
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Abstract:
Abstract Progressive disease is common following anal sacculectomy for apocrine gland anal sac adenocarcinoma (AGASACA); additional therapy may prolong survival. Adherence to medical recommendations influences therapeutic success in humans. The purpose of this study was to assess the adherence to follow‐up recommendations in dogs with AGASACA. Medical records of patients that underwent anal sacculectomy for AGASACA, with or without iliosacral lymphadenectomy, between July 2015 and July 2018, were reviewed at eight referral institutions to assess post‐operative recommendations and owner adherence to recommendations. One hundred and seventy‐four dogs were included, of which 162 underwent unilateral anal sacculectomy, 12 underwent bilateral anal sacculectomy and 39 underwent concurrent iliosacral lymphadenectomy. Seventy‐six owners (44%) received recommendations for staging at the time of discharge, histopathology results or at the first follow‐up visit. One hundred and forty owners (80%) received recommendations for treatment following the initial surgery. Fifty of seventy‐six (66%) owners pursued at least one staging recommendation and 69 of 140 (49%) owners pursued some kind of adjuvant treatment recommendation. Overall, 16 of 76 (21%) were adherent to staging recommendations with 20 adherent for the first year following surgery (26%). Forty‐seven of 140 (34%) were adherent to treatment recommendations with 54 (39%) adherent for the first year. Owners that were adherent to restaging recommendations at 1 year following surgery were significantly more likely to pursue treatment for progressive disease ( P = .014). Further work is required to assess owner motivation and evaluate strategies to improve adherence, given the potential impact on patient treatment.Keywords:
Lymphadenectomy
Histopathology
Medical record
OBJECTIVE: To investigate perioperative features and results of surgical treatment of spinal tuberculosis in aged. METHODS: Review the clinical data of 36 aged with spinal tuberculosis from May 1998 to June 2005 retrospectively. The average age was 70.2 years. The sites of infection included 3 cervical, 9 thoracic, 13 thoracolumbar and 11 lumbar. 28 patients suffered 1 or more complications at least and among of them, there were 18 patients have cerebral or heart vascular disease, 16 patients have diabetes mellitus. Before operation, all patients consulted with internal stuff for the proper treatment of concomitant disease. The surgical procedures include: CT guided percutaneous catheter drainage in 3 patients, anterior debridement and bony grafting with anterior instrumentation fixation in 12 patients, anterior debridement and bony grafting with posterior fixation in 5 patients, posterolateral costotransversectomy debridement and interbody fusion with posterior fixation in 7 patients, posterior debridement and posterior fixation in 9 patients. The mean followed-up period was 3 years and 10 months (from 1.5 to 6 years). RESULTS: One died at two week after the operation. Tuberculous infection was controlled in other patients and no recurrence. Two patients died because of myocardial infarction and cerebral hemorrhage respectively at 1.5 and 2.5 years after operation. Bone fusion was achieved in 31 patients. The deformity was partial corrected at the final follow-up. Among 20 cases with neurologic deficit, 11 cases were completely recovered, 5 cases were partly improved. CONCLUSIONS: If the associated disorders and postoperative complications are properly handled, aged patients can endure surgical treatment for spinal tuberculosis. Instrumentation fixation provides adequate stability and promote recovery.
Debridement (dental)
Bone grafting
Concomitant
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Sir,
Oral cancer is a serious and growing problem and it is the sixth most common cancer in the world. In high-risk countries such as Srilanka, India, Pakistan, and Bangladesh, oral cancer is the most common cancer in men and may contribute up to 25% of all new cases.[1] The higher incidence of oral cancer and pre-cancers has been linked with the habit of betel quid and tobacco chewing in India and it is estimated that among the 400 million individuals aged 15 years and above, 47% use tobacco in one form or the other in our country.[2] Patient delay has been cited as the main reason for late attendance and it seems probable that in both the high risk and general population, neither the symptoms of oral cancer, nor the main risk factors are well-understood.[3] Public awareness about the risk factors and methods of early detection of oral cancer is quite low.[3] It has also been observed that chronic tobacco chewers and smokers, who are at a higher risk, do not take advantage of community oral cancer screening programs, if offered. Even if, they come for screening they avoid undergoing for further diagnosis and management. The purpose of this study was to determine the reasons behind the non-attendance and non-compliance of patients with oral pre-cancer and cancer lesions detected in camp screening program for further diagnosis and management at the hospital. This study was approved by an ethical committee of the institute.
We organized oral cancer screening camps at UP State Government Transport Depot, Noida, Ghaziabad and nearby villages. High risk population comprising of drivers, conductors, farmers, and village population using the tobacco in any form were screened for oral pre-cancer and cancer lesions with Magnivisualizer® (magnifying device with white light illumination). Patients with positive lesions were referred to Guru Teg Bahadur (GTB) Hospital (20-40 km away from screening camp sites) for further management where facilities for biopsy and treatment were arranged free of cost. This hospital is a territory hospital having facilities for biopsy, surgery, and radiotherapy. Out of 150 patients diagnosed (with different positive for oral lesions, only 33 (22%) reached at GTB referral Hospital for further management. Remaining 117 (78%) patients refused to go for any management. Owing to social taboos only 3 females came forward for oral cavity examination and one reported to tertiary hospital. This is due to some social restrictions and for females health is not the first priority.
Out of 150 patients, 34 homogenous leukoplakias, 13 non-homogenous leukoplakia, 3 nodular leukoplakia, 2 leukoplakia, 4 oral lichen planus, 88 oral submucus fibrosis 5 other lesions (Candida), and one suspicious for cancer were diagnosed in camp. Each patient has been told about better management facilities of a tertiary hospital, which is attached to a Medical College.
A follow-up survey was conducted to determine the reasons behind the non-compliance of these 117 patients. Telephone numbers, mobile numbers and their contact numbers were already collected during the examination of patients. Patients have been told again and again about the free of cost facilities available in the hospital. These patients were contacted through telephone three to 4 times and were asked for reasons for their non-compliance.
Table 1 shows the reasons behind the non-compliance observed in these patients after the first screening. Shortage of time was the main reason for non-compliance in 27% of patients. Further analysis showed that the long distance of referral hospital from their residence was found to be the main complaint in 20 (17.1%) followed by odd hour duties in 7 (5.9%), and long duty hours in 6 (5.1%) of cases. The next significant reason was denial of any treatment in 18 (15.4%), dependence upon their destiny or fate in 13 (11.1%), addiction for tobacco consumption and non-willingness to leave this habit in 8 (6.8%), fear of time consumption in crowded government hospital or rush in getting medical treatment in 8 (6.8%), fear of diagnosis in 8 (6.8%) of the cases, no support from family and friends in 4 (3.4%), fear of teasing from friends and society in 8 (6.8%) and hesitation to accept treatment in 9 (7.8%) cases were some of the reasons explained by the patients behind the non-compliance and acceptance of treatment. Even 12 (10.3%) of them gave their wrong contact numbers or the contact numbers of their friends during the first screening.
Table 1
Reasons for non-compliance of patients to attend referral hospital after screening for oral cavity
Screenings are organized for 3-5 days, which is too short to build the confidence among patients. Local influential people/village administrative bodies should be included in motivation drive and should be convinced to volunteer themselves to provide means/and facilitate for treatment of patients, who are a farmer and labor. Senior bosses should be also approached to act as a figure head providing leave medical aid for those patients, who are in the job. For distant areas, a mobile van having the facilities for taking a biopsy on the site may be a good option for improving the compliance among patients.
Thus, cancer screening camps alone are not the solutions for any screening programs. A good awareness, involvement of local administrative bodies for follow-up and motivation program should be started before initiating any such program. The reasons behind non-compliance should be looked carefully and the problems should be worked out as far as possible for any successful screening program.
Rural population
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Seroma
Wound dehiscence
Incisional Hernia
Fat necrosis
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We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
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Abstract Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
Seroma
Bleed
Hernia Repair
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Objective To investigate the causes, the indications and operative procedures of reoperation for postoperative recurrence of hyperthyroidism. Method Clinical data of 34 cases of postoperative recurrence of hyperthyroidism received reoperation were analyzed retrospectively .Results The reoperative procedures including bilateral subtotal thyroidectomy in 29 cases, unilateral thyroidectomy in 5. All the 34 patients were cured by reoperation.The incidence of postoperative complication was 5.9%,which was not significantly different compared with primary operation treatment during the same time in our hospital.All the 34 case were followed up for 1～10 years,the results showed that all patients were alive well without recurrence or hypothyroidism .Conclusions Extension of the resected thyoid is not enough in the primary surgery is the main cause of postoperative recurrence of hyperthyroidism.Reoperation is the choise of therapy in selective patients with postoperative hyperthyroidsm recurrence .Careful intraoperative dissection can help to avoid injuries of recurrent nerve and parathyroid,and to prevent massive bleeding.
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Chylothorax
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Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Seroma
Incisional Hernia
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To explore the referral pathways of patients with newly diagnosed colorectal cancer to surgeons.Australian surgeons from three states completed a questionnaire and their records were audited.Thirty-three surgeons provided data on 530 patients seen in the preceding 12 months. The median time between colonoscopy and first surgical consult was 10 days, with 19% of patients waiting more than 28 days. After adjustment for clustering, no surgeon factors were associated with the number of days between colonoscopy and surgery. A report back to the general practitioner (GP) was found in 78% of patients' records. This feedback varied between surgeons but none of the specific surgeon characteristics examined could explain this.Surgeons usually communicated with GP regardless of whether they were the referral source. However, communication with GP varied considerably among surgeons, with no evidence of a report to the GP in one-fifth of cases.
Colorectal Surgery
Medical record
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