RESUMO
The aim of this study is to assess patient satisfaction, success at controlling symptoms and conversion rates to open surgery in patients undergoing pharyngeal pouch surgery using an endoscopic stapler in a second cycle of audit. The design consisted of a review of patient records augmented by an electronic search of operation codes in the hospitals' theatre records. The setting was in Worcester Royal Hospital, BUPA Southbank Hospital and Hereford Hospital, UK. Participants include all patients with pharyngeal pouches undergoing endoscopic pharyngeal pouch repair by the senior author between July 2002 and July 2007. The total number of participants was 31. All patients were undergoing treatment for the first time. The main outcome measures were pre- and postoperative symptom prevalence, conversion rates to open surgery, patient satisfaction. Endoscopic pharyngeal pouch surgery was successful in the vast majority of cases, with 97% of patients being satisfied with the result. The conversion rate to open surgery was 9.7%. These figures are improved from the last round of audit. In conclusion, endoscopic surgery to treat pharyngeal pouches is safe, effective and patient selection is improving. A modified method of endoscopy using a Negus scope rather than a Baldwin scope has allowed more patients to be treated via endoscopic methods. Open surgery is still required in some patients.
Assuntos
Endoscopia/métodos , Auditoria Médica , Grampeamento Cirúrgico , Divertículo de Zenker/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Garantia da Qualidade dos Cuidados de Saúde , Divertículo de Zenker/diagnósticoAssuntos
Ictiose/genética , Proteínas de Filamentos Intermediários/genética , Mutação , Adolescente , Adulto , Idoso , Alelos , Feminino , Proteínas Filagrinas , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
We study a fluid jet descending through stratified surroundings at low Reynolds number in Hele-Shaw flow. The jet buckles and overturns inside a conduit of entrained fluid which supports smooth or unstable traveling waves. A model of the recirculating flow within the conduit shows that buckling and waves arise from Kelvin-Helmholtz instabilities and quantitatively accounts for the main experimental observations. Beyond the onset of the instability, a damped, forced Burgers' equation obtained from corrections to Darcy's law for small Reynolds number governs the interface dynamics and supports singularities corresponding to the observed jet overturning and unstable waves.
