Results Of Different Operations Research Articles

OPTIMIZATION OF THE METHOD OF SURGICAL TREATMENT OF PRIMARY INFANTILE CONGENITAL GLAUCOMA IN CHILDREN

Pediatric glaucoma is a term that encompasses several forms of congenital glaucoma and types of secondary glaucoma thatdiff er in etiology, pathogenesis, and clinical presentation. Surgical treatment is the main method of IOP reduction in pediatricglaucoma. To date, no uniform method of surgical treatment of infantile glaucoma has been proposed, which makes the searchfor adequate methods of surgical intervention in this pathology most urgent.The aim of this work was to evaluate the effi cacy of surgical treatment of primary congenital infantile glaucoma in children.Material and methods. In the eye department of the clinic of the Tashkent Pediatric Medical Institute, the eff ectiveness of themethod of surgical intervention in children from 3 to 10 years old with primary congenital infantile glaucoma was evaluated.Examined – 20 patients (40 eyes). Of these, 5 patients (10 eyes) entered the advanced stage, 10 patients (20 eyes) entered the far advanced stage, and 5 patients (10 eyes) entered the terminal stage, respectively. The patients underwent standard ophthalmological examination. The state of the optic nerve was investigated by optical coherence tomography Stratus OCT-3000 (Carl Zeiss Meditec), the visual fi elds – in 10 (20 eyes) patients aged over 8 years using standard automated and computer perimetry (SAP).Conclusions of the bioethical commission: This article evaluates the eff ectiveness of the method of surgical treatment ofprimary congenital infantile glaucoma in children. And gives specifi c results of diff erent operations at diff erent stages of primary congenital infantile glaucoma. Surgical treatment was chosen according to the degree of goniodysgenesis and the stage of the disease, which showed a satisfactory result in stabilizing the glaucoma process.Statistical analysis method using Microsoft Excel and SPSS programs was used for processing the results of theophthalmological study. Diff erences between the mean values (M±σ) were considered reliable at P≤0.05.Results and Discussion. All patients underwent surgical treatment, depending on the severity of morphometric changesin the anterior chamber angle, and in the postoperative period with an interval of 6 months – a course of neuroprotectivetherapy. According to the examinations, children with primary infantile glaucoma in advanced stage underwent non-penetrating deep sclerectomy in 10 eyes, with extensive – in 20 eyes and with terminal – in 10 eyes – sinusotrabeculotomy ab externo, sinusotrabeculectomy. In 2 eyes in the terminal stage, fi ltering surgery was performed according to the proposed method. Thus, the above methods of surgery reduce the number of intra- and postoperative complications by 12.5%, avoid reoperations, reduce IOP in 12.3% of cases, increase visual acuity by 0.15 compared to the original.Conclusion. The above methods of surgical treatment were chosen according to the degree of goniodisgenesis and the stageof the disease, which showed a satisfactory result in stabilizing the glaucoma process

P-748 Fertility and anatomical outcome following hysteroscopic adhesiolysis of intrauterine adhesions classified according to symptoms, imaging findings and hysteroscopic appearance of the uterine cavity

Abstract Study question To classify patients with dense intrauterine adhesions based on clinical characteristics as well as, ultrasound, hysterosalpingography (HSG) and hysteroscopy findings into different prognostic groups. Summary answer We have defined a prognostic model to classify patients with dense intrauterine adhesions which could easily be implemented in patient counseling and management. What is known already Intrauterine adhesions are a major cause of hypo-amenorrhea and failure to conceive. A universally agreed classification to categorize intrauterine adhesions is paramount to provide individualized counseling and care. Previous efforts for categorization suffer from limitations such as variable assessment of anatomical outcomes, application of different techniques, pooling of results of different operators and lack of long-term follow-up. Many experts have voiced a call for a prognosis-oriented classification system. An ideal classification model should consider clinical characteristics, findings from imaging techniques (including ultrasound and HSG) together with hysteroscopic appearance of the uterine cavity and demonstrate a high predictive value. Study design, size, duration This is a retrospective analysis of 281 patients treated for intrauterine adhesions by a single operator (B.U.) between 2010 and 2021. Lysis of adhesions was affected in 479 office hysteroscopy procedures using the Versapoint bipolar cutting electrode under transabdominal ultrasound guidance. 227 patients were followed for at least 15 months after the last surgical procedure. Patients were classified into five categories (Class I to V) according to their symptoms, ultrasound, HSG and hysteroscopy findings. Participants/materials, setting, methods Clinical data and operative findings were reviewed from patient files and video recordings. The number of hysteroscopic interventions needed to restore the cavity and the reproductive outcome in women who were desirous for pregnancy were recorded. Predictive power of the model was assessed using the live birth rate as the primary and rate of cavity restoration and number of interventions as the second outcome parameters. Groups were compared using ANOVA, ROC and regression analyses. Main results and the role of chance Adhesions were classified as class I in 43 (15.3%), class II in 72 (25.6%), class III in 57 (20.3%), class IV in 82 (29.2%) and class V in 27 (9.6%) patients. They were due to previous curettages of pregnancies (79,7%) or retained products of gestation (3.9%), prior uterine surgery (6.8%), prior hysteroscopy of inappropriate technique (6.8%) and tuberculosis (2.8%). The cavity was septate in 12 and unicornuate in 2 patients. The mean age of the study group was 29.8 ± 3.7 (20-40). Age was not related with the severity of adhesions (p = 0.335). While the majority of patients with curettage-related adhesions were classified as Class II, uterine surgery, iatrogenic and tuberculosis related adhesions were higher in severity. The number of hysteroscopic adhesiolysis procedures (from 1.0 ± 02. to 2.3 ± 0.5) needed for optimal restoration of the cavity was directly related and the rate of full restoration (from 100% - 18.5%) was indirectly related with the severity of adhesions according to the proposed classification (p = 0.0001 for both). The live birth rates were 54.3%, 45%, 31.7%, 21% and 12.5% for patients in Class I to V, respectively (p = 0.0001). The proposed classification was fairly predictive (AUC: 0.654, 95%CI: 0.582-0.727) for live birth. Limitations, reasons for caution This is a retrospective analysis of consecutive patients with intrauterine adhesions in routine practice. The follow-up for reproductive outcome is limited. The study is hospital-based and single-center. Thus, the predictive value of the proposed classification needs to be validated in an external data set preferably in a prospective series. Wider implications of the findings In patients with intrauterine adhesions, a classification system based on patient symptoms, imaging findings and hysteroscopic appearance of the uterine cavity reliably predicts the postoperative outcome in terms of the extent of anatomical restoration of the uterine cavity and pregnancy and live birth rates. Trial registration number Not applicable

Актуальні проблеми класифікації аноректальних вад розвитку в дітей у сучасних умовах (огляд літератури)

Given the diversity of anatomical and functional manifestations of congenital anorectal malformations, the most relevant remains development of classification of this pathology, for the same understanding by doctors of the manifestations of this defect and developing optimal common criteria for treatment tactics and strategies. The paper presents historical and current information on the classification of anorectal malformations in children. The main contradictory issues of the existing classifications are identified. The relevance of the use of Krickenbeck classification in the treatment of these defects is highlighted. Under the influence of different colorectal schools, historically, different educational and methodological approaches to the treatment of anorectal malformations. The first International Congress of Pediatric Surgeons was held in Melbourne, Australia, in 1970. The Melbourne meeting established an international classification of anorectal malformations. It was based on the development of defects at the stages of embryogenesis and their division by sex. Also, they are divided into: low, intermediate and high anorectal malformations. The second World Meeting of Pediatric Surgeons was held in Wingspread, Wisconsin, USA, in 1984, when F. D. Stephens and E. Smith, with a group of experts from around the world, proposed a detailed PAHR classification. The advantage of the Wingspread classification was that it could be used to predict the most optimal surgical treatment for various variants of anorectal defects. The third international conference on the development of standards for the treatment of congenital anorectal malformations took place in Krickenbeck, Germany, in 2005. This conference radically changed the latter classification, removing the terms «low», «intermediate» and «high» and the differences between female and male anomalies. The assessment depended on the presence and type of fistula. The reason for adopting such a classification was the great difficulty in comparing the results of different operations according to the old Wingspread classification. The peculiarity of this classification is the great contribution of colleagues from the Indian and Asian subcontinents to the surgical treatment of several anomalies, in particular: Pouch colon, which are rare in other countries. Today, pediatric surgeons in Ukraine generally do not use the Krickenbeck classification, despite the fact that it is generally accepted in most countries. This leads to the application of different approaches to the surgical treatment of congenital anorectal malformations, which emphasizes the relevance of further study of this issue. The informed consent of the patient was obtained for conducting the studies. Key words: congenital anorectal malformation, classification, children.

State Transition Graphs for Semantic Analysis of Movement Behaviours

A behaviour can be defined as a sequence of states or activities occurring one after another. A behaviour consisting of a finite number of reoccurring states/activities may be represented by a directed weighted graph with nodes and edges corresponding, respectively, to the possible states and transitions between them, while the weights represent the probabilities or frequencies of the state and transition occurrences. The same applies to multiple behaviours sharing the same set of possible states. In analysis of movement data, state transition graphs can be used to represent semantic abstractions of mobility behaviours, where states correspond to semantic categories of visited places (such as ‘home’, ‘work’, ‘shop’), activities of moving objects (‘driving’, ‘walking’, ‘exercising’, etc.) or characteristics of the movement (‘straight movement’, ‘sharp turn’, ‘acceleration’, ‘stop’, etc.). Such a representation supports the exploration and analysis of the semantic aspect (i.e. the meaning or purposes) of movement. For comprehensive analysis of movement data, state transition graphs need to be combined with representations reflecting the spatial and temporal aspects of the movement. This requires appropriate coordination between different visual displays (graphs, maps and temporal views) and appropriate reaction to analytical operations applied to any of the representations of the same data. We define in an abstract way the reactions of a graph display to analytical operations of querying, partitioning and direct selection. We also propose visual and interactive display features supporting comparisons between data subsets and between results of different operations. We demonstrate the use of the display features by examples of real-world and synthetic data sets.

Operator bias in software-aided bat call identification.

Software-aided identification facilitates the handling of large sets of bat call recordings, which is particularly useful in extensive acoustic surveys with several collaborators. Species lists are generated by “objective” automated classification. Subsequent validation consists of removing any species not believed to be present. So far, very little is known about the identification bias introduced by individual validation of operators with varying degrees of experience. Effects on the quality of the resulting data may be considerable, especially for bat species that are difficult to identify acoustically. Using the batcorder system as an example, we compared validation results from 21 volunteer operators with 1–26 years of experience of working on bats. All of them validated identical recordings of bats from eastern Austria. The final outcomes were individual validated lists of plausible species. A questionnaire was used to enquire about individual experience and validation procedures. In the course of species validation, the operators reduced the software's estimate of species richness. The most experienced operators accepted the smallest percentage of species from the software's output and validated conservatively with low interoperator variability. Operators with intermediate experience accepted the largest percentage, with larger variability. Sixty-six percent of the operators, mainly with intermediate and low levels of experience, reintroduced species to their validated lists which had been identified by the automated classification, but were finally excluded from the unvalidated lists. These were, in many cases, rare and infrequently recorded species. The average dissimilarity of the validated species lists dropped with increasing numbers of recordings, tending toward a level of ˜20%. Our results suggest that the operators succeeded in removing false positives and that they detected species that had been wrongly excluded during automated classification. Thus, manual validation of the software's unvalidated output is indispensable for reasonable results. However, although application seems easy, software-aided bat call identification requires an advanced level of operator experience. Identification bias during validation is a major issue, particularly in studies with more than one participant. Measures should be taken to standardize the validation process and harmonize the results of different operators.

ISO 9000:2000 certification and business results

PurposeThe purpose of this paper is to explore the relationship between ISO 9000:2000 certification and business results. It aims to provide reliable and valid constructs for measuring quality results and operative results in a specific sector: the furniture industry in Spain and to test the effects of certification on the aforementioned results.Design/methodology/approachA questionnaire survey was conducted in 130 Spanish companies. Confirmatory factor analysis tests were used to verify scales validity and reliability. The analysis of the variance (ANOVA) was utilised to investigate the statistical effects of ISO certification.FindingsThe results revealed two reliable and valid constructs: quality results and operative results. These measurement scales differentiated all the certified companies in the sample from the non‐certified enterprises due to the better results obtained by the former.Originality/valueAlthough some studies have concentrated on analysing different quality results deriving from certification and the results of different operations, there is still a clear need for research using previously validated tools to measure results. This research aims to fill this gap by validating two scales to measure both types of results: quality results and operative results.

Criteria for the Evaluation of Surgical Results

This brief article presents general criteria for evaluating results of different operations for hearing, vertigo, and disability. Also reviewed are the 1985 guidelines of the Committee on Hearing and Equilibrium of the American Academy of Ophthalmology and Otolaryngology, which are currently being revised.

The anal sphincter force in the evaluation of postoperative imperforate anus

Eighty-four children, all of whom had imperforate anus, were evaluated by measuring the anal sphincter force (ASF). Sixty-three were boys, 46 of whom had a high imperforate anus and 17 of whom had the low anomaly. There were 7 girls with cloacal malformations, 7 girls with high type and 7 with low type of malformation. In all the boys with a high imperforate anus the ASF ranged from 50 to 300 g. Those boys with a low type had an average ASF of 513 g. Normal values vary from 480 to 600 g. Twenty-five of the boys with a high imperforate anus had undergone posterior sagittal anorectoplasty and none were clinically continent. Their ASF measurements were lower than in patients with spina bifida. Patients with a low anomaly, both boys and girls, were continent and had high ASF readings. The ASF is a simple, inexpensive, and objective measurement of fecal incontinence when this is the consequence of muscular inadequacy. A reproducible quantification is now available to compare results of different operations and different centres.

Metatarsalgia due to insufficient support by the first ray.

Sixty-five feet with metatarsalgia due to inadequate support by the first ray are presented. A classification of different types of deficient anteromedial support is proposed in relation to the morphology of the first ray. When there is deficient anteromedial support and the first ray is normal, the ray is elevated and may or may not be associated with supination of the forefoot. When there is elevation of the first ray alone, operations are proposed which restore normal anteromedial support. The decision for choosing a particular type of operation is determined by an analysis of the cause of the elevation. There operations can be on the soft tissues, bone or both. When loss of anteromedial support is the consequence of complete supination of the forefoot, this has been corrected by a tarsal derotation osteotomy. Supination of the forefoot may be accompanied by elevation of the first ray. In there cases, the derotation osteotomy has been complemented by one of the operations described in the case of simple elevation of the first ray. The different indications of these surgical procedure are described as well as the results. In the case of deficient anteromedial support with an abnormal first ray, the treatment was conservative or surgical. The results of different operations performed to restore the normal loading under the forefoot are described.

Hemigastrectomy and truncal vagotomy in the treatment of duodenal ulcer: With a summary of related secretory data emphasizing preoperative basal acidity and postoperative basal-insulin achlorhydria

We have found carefully performed basal acidity studies before and basal-insulin testing after operation to be very helpful. The preoperative basal acidity data provide a simple physiologic basis for classifying patients and, because of the wide range of fasting gastric acidity from patient to patient (0 to 56.6 mEq/hr), alert one to the magnitude of the secretory problem that one is attempting to correct by means of an operation. (Tables II and IV.) The postoperative basal-insulin data identify the patients who are achlorhydric and consequently protected against recurrence and those who are not and in whom a recurrence may therefore develop. (Table VIII.) The preoperative basal acidity data used in conjunction with the incidence of postoperative basalinsulin achlorhydria serve as an excellent basis for judging the results of different operations and for selecting the most effective procedure for a given patient. (Table VI.) For patients who are not achlorhydric, the postoperative basal-insulin data reveal the quantity of acid still present. This, in turn, indicates whether the patient is in the category that contains the great majority of recurrent ulcers. It also identifies the cases which have the largest amount of residual vagal activity and serves as an additional basis for judging the results of different operations. (Table IX.) These secretory data enabled us to identify hemigastrectomy with vagotomy as a procedure that would in all probability be very effective in preventing recurrent ulceration twenty years before [1,2] the clinical results [4] justified that conclusion and indicated that it would be more effective than other operations in this regard. (Tables VI and IX.) We recommend truncal vagotomy with hemigastrectomy or antrectomy (40 per cent resection) as the procedure of choice for the management of duodenal ulcer when no contraindications to its use are present. We recommend truncal vagotomy with a drainage procedure for poor risk patients undergoing emergency or elective surgery. Many patients over sixty should be managed in this manner. In good risk patients and elective situations in which resection is contraindicated because of disease in the duodenal area, we would call attention to the fact that truncal vagotomy combined with gastroenterostomy has been more effective than when combined with pyloroplasty in controlling acidity especially in the higher preoperative basal acidity zones. (Table VI.) This group of patients might benefit from some selective or modified truncal technic for vagotomy if it can be used with uniform success by qualified surgeons and if the postoperative basal-insulin secretory data indicate that the late results may be expected to be significantly improved over those of truncal vagotomy with drainage. When vagotomy cannot be performed, subtotal gastrectomy (two thirds) of the Billroth II type is indicated. When neither vagotomy nor resection can or should be performed, gastroenterostomy should be used.

Investigations Into the Mechanical Properties of Alpine Snow-Packs

Data on the physical properties of seasonal alpine snow have been collected from the Beartooth Mountains near Cooke City, Montana (elevation ≈3000 m) and the Bridger Range near Bozeman, Montana (elevation ≈2200 m). Systematic measurements of snow density, temperature, structure, ram and Canadian hardness, centrifugal tensile strength and shear strength measured with a shear box and several types of shear vanes are included. Test results were grouped according to gross snow types (cohesive fine-grained “winter” snow. depth hoar, new snow, etc.) and whether the snow was wet or dry. Then interrelations between the different test parameters were studied. A plot of ram number versus density for winter snow gave a log-linear relation similar to that suggested for polar snows. Both shear-vane and centrifugal-tensile results when plotted as a function of porosity are well described by the negative exponential relation suggested by Ballard and Feldt. Depth hoar and wet snow invariably have lower strength values at any given density. There is an excellent one-to-one agreement between values obtained with the shear vane and the shear box.Several field experiments were performed to study the sources of error in making in-situ mechanical tests on snow without utilizing a pit wall. Statistical analysis of the results shows that the main factor contributing to the experimental scatter is lateral inhomogeneity in the snow cover. There was no significant difference between the results of different operators. The standard deviation of a group of strength tests is shown to be directly proportional to the mean value of the group. This indicates that a logarithmic transformation should be made in handling snow strength results in order to stabilize the variance. It is emphasized that the systematic relations between snow properties invariably become obscured when different snow “types” are indiscriminately grouped together.

Investigations Into the Mechanical Properties of Alpine Snow-Packs

Data on the physical properties of seasonal alpine snow have been collected from the Beartooth Mountains near Cooke City, Montana (elevation ≈3000 m) and the Bridger Range near Bozeman, Montana (elevation ≈2200 m). Systematic measurements of snow density, temperature, structure, ram and Canadian hardness, centrifugal tensile strength and shear strength measured with a shear box and several types of shear vanes are included. Test results were grouped according to gross snow types (cohesive fine-grained “winter” snow. depth hoar, new snow, etc.) and whether the snow was wet or dry. Then interrelations between the different test parameters were studied. A plot of ram number versus density for winter snow gave a log-linear relation similar to that suggested for polar snows. Both shear-vane and centrifugal-tensile results when plotted as a function of porosity are well described by the negative exponential relation suggested by Ballard and Feldt. Depth hoar and wet snow invariably have lower strength values at any given density. There is an excellent one-to-one agreement between values obtained with the shear vane and the shear box. Several field experiments were performed to study the sources of error in making in-situ mechanical tests on snow without utilizing a pit wall. Statistical analysis of the results shows that the main factor contributing to the experimental scatter is lateral inhomogeneity in the snow cover. There was no significant difference between the results of different operators. The standard deviation of a group of strength tests is shown to be directly proportional to the mean value of the group. This indicates that a logarithmic transformation should be made in handling snow strength results in order to stabilize the variance. It is emphasized that the systematic relations between snow properties invariably become obscured when different snow “types” are indiscriminately grouped together.