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de Ruiter GCW, Lobatto DJ, Wolfs JF, Peul WC, Arts MP. Reconstruction with expandable cages after single- and multilevel corpectomies for spinal metastases: a prospective case series of 60 patients. Spine J 2014; 14:2085-93. [PMID: 24448192 DOI: 10.1016/j.spinee.2013.12.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/11/2013] [Accepted: 12/30/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Expandable cages are widely used to reconstruct the spine after the removal of vertebral metastases. Long-term results, however, are lacking, and there is little information on reconstruction after multilevel corpectomies. PURPOSE To determine long-term outcome for reconstruction of the spine with expandable cages after single and multilevel corpectomies for spinal metastases. STUDY DESIGN A prospective cohort study of 60 consecutive patients with spinal metastases treated with expandable cages. METHODS All patients were prospectively followed with regular clinical and radiographic evaluation. Outcome measures were the Frankel score, patients' self-reported recovery, radiological alignment of the spine, and neurologic plus biomechanical complications. RESULTS Sixty patients were treated with expandable cages in our hospital in a 5-year period with a maximum follow-up of 6 years. Single-level reconstruction was performed in 48 cases, 2-level in 8, and 3-level in 4. Postoperatively, the Frankel score had improved significantly (p=.03), the segment height had increased (p=.02), and, in severe cases of kyphosis (>20°), the regional angulation had been corrected compared with preoperatively (p<.001). Complication rate, however, was high (36.7%), in particular after multilevel reconstruction, in which three cases had to be reoperated years after the initial surgery; reasons for this were hardware failure, progressive kyphosis, and bronchial perforation. Good recovery was reported in 70% of all patients. CONCLUSIONS Expandable cages can be used successfully in reconstruction of the spine after single and multilevel corpectomies for spinal metastases. However, long-term complication rate is high. Promotion of bony fusion, prevention of soft-tissue damage, adequate posterior stabilization, and careful patient selection may reduce these complications.
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Ganeval-Stoll A, Bruant-Rodier C, Dissaux C, Lutz JC, Wilk A, Bodin F. [Squamous cell carcinomas of the ear: factors of gravity and surgical treatment, about 30 cases]. ANN CHIR PLAST ESTH 2014; 59:226-31. [PMID: 24924097 DOI: 10.1016/j.anplas.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 05/01/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Squamous cell carcinomas (SCC) of the ear are known for their aggressiveness. The aim of this study was to investigate factors of gravity while freeing the therapeutic requirements. PATIENTS AND METHODS This is a retrospective study of 28 patients (30 ears) operated for SCC. The characteristics of the lesion, the presence of metastasis, treatment modalities and histologic findings were collected. Local recurrences and metastasis are identified with a mean follow-up time of 37months (17-110months). RESULTS The lesion size was less than 2cm in 19 cases (63.3%) and greater than or equal to 2cm in 11 cases (36.7%). Macroscopic resection margins were 5, 7 or 10mm. The resections were histologically incomplete in 4 cases (13%) requiring further surgery. Six cases had local recurrence (20%): three with pulmonary or lymph node metastases (10%) and one death (3.3%). In these 6 cases of recurrence, the surgical margins were 6.3mm on average, the initial lesion measured always greater than 2cm (100%). Three quarters of incomplete resections have recurrent despite a surgical revision in healthy margin. CONCLUSION Our study confirms the data of literature, namely the pejorative character of a lesion greater than 2cm and incomplete resection. The HAS recommendations seem minimal regarding the ear. In case of injury by more than 2cm and with a proximal location on the ear pinna, only amputation of the ear allows satisfactory cancer control.
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Novegno F, Umana G, Di Muro L, Fraioli B, Fraioli MF. Spinal intramedullary arachnoid cyst: case report and literature review. Spine J 2014; 14:e9-15. [PMID: 24262859 DOI: 10.1016/j.spinee.2013.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/21/2013] [Accepted: 10/31/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary arachnoid cysts are extremely rare; only 14 cases have been reported in the literature so far. PURPOSE We report on the case of a 31-year-old woman who presented with back pain and progressive paraparesis secondary to a dorsal intramedullary arachnoid cyst detected on magnetic resonance imaging (MRI): the surgical planning and clinico-radiological outcome are discussed along with a review of the relevant literature. STUDY DESIGN Case report and literature review. PATIENT SAMPLE One patient affected by intramedullary arachnoid cyst. OUTCOME MEASURES Magnetic resonance imaging and pathological findings from operative specimens were used to confirm the diagnosis. METHODS A 31-year-old woman presented with a 7-year history of back pain that had worsened 3 months before admission to our department; for this reason, the patient had undergone a spinal MRI revealing the presence of a 1-cm cystic intramedullary lesion at the level T11-T12, with no contrast enhancement. After 2 months, the patient presented with a worsening of clinical symptoms complaining of severe back pain radiating to the lower extremities associated with a progressive paraparesis, urinary incontinence, and abdominal pain. Referred to our department, at the time of admission the patient was bedridden because of the impossibility of maintaining a standing position. The patient underwent a T11-T12 laminectomy with fenestration of the cyst. RESULTS She experienced an immediate relief of pain symptoms, and by the seventh postoperative day she was able to stand without help and walk a few meters with assistance. By the sixth postoperative month, the patient had significantly improved, having gained the ability to walk alone without assistance with complete resolution of the bladder dysfunctions, with no cyst recurrence after approximately 2 years of follow-up. CONCLUSIONS Intramedullary arachnoid cysts should be considered in the differential diagnosis for intramedullary cystic lesions. A particular consideration deserves their occurrence in asymptomatic patients, who should be adequately informed on the possible natural evolution: when symptomatic, surgical therapy should be promptly offered, considering that a postoperative complete recovery is usually observed, regardless of the surgical technique.
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Bertrand B, Philandrianos C, Apostolou N, Casanova D, Bardot J. [Technical note: iliac crest bone graft harvesting in children]. ANN CHIR PLAST ESTH 2014; 59:215-8. [PMID: 24512894 DOI: 10.1016/j.anplas.2013.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022]
Abstract
Harvesting iliac crest bone in children is special because of the presence of a thick cartilage. Constant pressure on the internal iliac fossa, ascends the skin, and moves the abdominal muscles away from the iliac crest. A single incision is then used for cutaneous and subcutaneous dissection. An internal piece of cartilage is then removed and the iliac muscle retracted in order to harvest cortical and spongy bone from the internal side of the iliac crest. That pièce of cartilage is then sutured at its initial place. During the harvesting, the surgeon needs to be careful to preserve the lateral femoral cutaneous nerve.
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Lu GQ, Li G, Ainiwaer·Julaiti, Li DS, Xiaheding·Yiliyaer, Zhang LW. Ivor-Lewis esophagectomy versus one-incision esophagectomy via the left thoracic approach in the treatment of middle and lower thoracic esophageal carcinoma. Shijie Huaren Xiaohua Zazhi 2013; 21:3710-3714. [DOI: 10.11569/wcjd.v21.i33.3710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the short-term efficacy and postoperative complications of Ivor-Lewis esophagectomy and one-incision esophagectomy via the left thoracic approach in the treatment of middle and lower thoracic esophageal carcinoma.
METHODS: Clinical data for 269 patients with middle or lower thoracic esophageal carcinoma who underwent surgical treatment between January 2010 and December 2012 were analyzed retrospectively, of whom 114 received Ivor-Lewis esophagectomy and 155 received one-incision esophagectmy via the left thoracic approach. The data regarding surgical procedures and perioperative complications were compared between the two groups.
RESULTS: The number of resected lymph nodes was significantly less in the Ivor-Lewis esophagectomy group than in the one-incision esophagectomy group (16.5 ±3.5 vs 11.6 ±2.2, P < 0.001). The rate of lymph node metastasis (15.72% vs 8.14%, χ2 = 6.32, P < 0.05) and the positive rate of surgical margins (0% vs 1.9%, P < 0.05) were statistically significant between the two groups. There was no significant difference in the rate of perioperative complications (23.7% vs 27.7%, P > 0.05), but the rates of respiration failure and arrhythmia were lower and the length of postoperative hospital stay were shorter in the Ivor-Lewis esophagectomy group.
CONCLUSION: Ivor-Lewis esophagectomy is superior to one-incision esophagectomy via the left thoracic approach in the treatment of middle and lower thoracic esophageal carcinoma in terms of lymph node dissection, the positive rate of surgical margin, postoperative recovery, and the rates of respiration failure and arrhythmia.
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Choi HS, Kim MS, Jung YJ, Kim OL. Incidental Superior Hypophygeal Artery Aneurysm Embedded within Pituitary Adenoma. J Korean Neurosurg Soc 2013; 54:250-2. [PMID: 24278658 PMCID: PMC3836936 DOI: 10.3340/jkns.2013.54.3.250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 05/28/2013] [Accepted: 08/19/2013] [Indexed: 11/29/2022] Open
Abstract
Intra-cranial aneurysm can be incidental findings in patients with pituitary adenomas, and are usually located outside the pituitary region. However, the coexistence of intrasellar (not intracranial) aneurysms with pituitary adenomas is extremely rare. We report a patient with an incidental superior hypophygeal aneurysm embedded within a non-functional pituitary adenoma which was treated by transsphenoidal surgery after endovascular coil embolization.
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Kim M, Lee HE, Oh SJ. Technical aspects of holmium laser enucleation of the prostate for benign prostatic hyperplasia. Korean J Urol 2013; 54:570-9. [PMID: 24044089 PMCID: PMC3773585 DOI: 10.4111/kju.2013.54.9.570] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/26/2013] [Indexed: 11/18/2022] Open
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.
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Kang JY, Chang HS, Hwang YC, Hwang IN, Oh WM, Lee BN. Autogenous tooth transplantation for replacing a lost tooth: case reports. Restor Dent Endod 2013; 38:48-51. [PMID: 23493816 PMCID: PMC3591586 DOI: 10.5395/rde.2013.38.1.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/24/2012] [Accepted: 01/12/2013] [Indexed: 11/11/2022] Open
Abstract
The autogenous tooth transplantation is an alternative treatment replacing a missing tooth when a suitable donor tooth is available. It is also a successful treatment option to save significant amount of time and cost comparing implants or conventional prosthetics. These cases, which required single tooth extraction due to deep caries and severe periodontal disease, could have good results by transplanting non-functional but sound donor tooth to the extraction site.
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159
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Lafont Rufat M, Nadal Cristobal B, Saura Fillat E, Ruiz de la Cuesta Martín D. Platysma flap: an alternative to free flaps. J Maxillofac Oral Surg 2013; 13:84-6. [PMID: 24821995 DOI: 10.1007/s12663-013-0485-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective of this paper is to show that platysma flaps have good results and should be an alternative in reconstructive surgery for oral tumors when microsurgery is not possible. It is a versatile, portable, and thin flap, is easy to perform, and can be obtained during neck dissection, with a primary closure of the donor site. METHODS Five cases are presented, three men and two women, 51 and 71 years old, with medium size (2-4 cm) defects of oral cavity after the excision of squamous cell carcinomas. All of them were reconstructed with a platysma flap after neck dissection. This reconstruction technique was chosen because of the poor conditions of these patients to allow a microsurgical reconstruction. RESULTS Non-local complications occurred with this technique. Overall aesthetic results were acceptable in all the patients. There were no cases of total necrosis flap, dehiscence, fistula or fibrosis. Only one case of partial necrosis occurred in one end of the flap, which was resolved with excision of necrotic tissue and closure by secondary intention. CONCLUSION The platysma flap is a good method to reconstruct small and medium sized defects of oral cavity, especially in patients where a microsurgery reconstruction is not possible.
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Song AR, Yang HS, Byun E, Kim Y, Park KH, Kim KL. Surgical treatments on patients with anterior cervical hyperostosis-derived Dysphagia. Ann Rehabil Med 2012. [PMID: 23185741 PMCID: PMC3503952 DOI: 10.5535/arm.2012.36.5.729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Anterior cervical hyperostosis may be a cause of dysphagia. For anterior cervical hyperostosis, medical or surgical treatments can be adhibited in view of the causative mechanisms and intensities of dysphagia. We report 3 cases of cervical hyperostosis-derived progressive dysphagia that underwent operation. Radiologic diagnosis and Video Fluoroscopic Swallowing Study were performed on the three patients for evaluation. One had history of recurrent aspiration pneumonia accompanied by weight loss, another complained of dysphagia only when swallowing pills, and the third experienced recurrence symptom with reossification. All patients reported gradual improvement of dysphagia immediately after their cervical osteophytes were resected through the anterior approach. In relation to postoperative improvement, however, they expressed different degrees of satisfaction according to severity of symptoms. Surgical treatment, performed for the anterior cervical hyperostosis-derived dysphagia, can immediately relieve symptoms of difficulty in swallowing. This might especially be considered as an appropriate treatment option for severe dysphagia.
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Bae CH, Kwon OC, Lee S, Lee CH, Cho JW. Cystic Mass on Right Atrium of Unusual Form of Chiari's Network: A Case Report. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:254-6. [PMID: 22880172 PMCID: PMC3413832 DOI: 10.5090/kjtcs.2012.45.4.254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 04/19/2012] [Accepted: 04/28/2012] [Indexed: 11/22/2022]
Abstract
Chiari's networks are present in 1.5% to 4% of the population. They are a congenital disease characterized by a remnant of the right valve of sinus venosus and rarely have clinical significance. Chiari's network, as the name implies, has network-like shape, but there are other forms of appearance. We have experienced a case of a 60-year-old woman who had a cystic mass on the right atrium. Surgical treatment was performed forthe mass removal and differential diagnosis of the mass. There was no evidence of other tumor, but Chiari's network. As cystic form of Chiari's network have not been reported before, it is the first report of cystic form of Chiari's network.
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Kirtane MV, Lall A, Chavan K, Satwalekar D. Endoscopic repair of lateral sphenoid recess cerebrospinal fluid leaks. Indian J Otolaryngol Head Neck Surg 2012; 64:188-92. [PMID: 23730584 PMCID: PMC3392343 DOI: 10.1007/s12070-011-0144-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/30/2011] [Indexed: 10/18/2022] Open
Abstract
Endoscopic repair of anterior cranial base has been widely reported. However there is still no uniformity in the technique of endoscopic repair of lateral sphenoid cerebrospinal fluid (CSF) leaks. To highlight the management of CSF leak or encephalocele in the lateral sphenoid recess and relate our experiences. We retrospectively reviewed the medical records of all our patients who underwent an endoscopic repair of CSF leaks in the lateral sphenoid recess during the period from September 2003 to January 2010 at our tertiary hospital. Fifteen cases with CSF leaks/encephalocele that were repaired by the endoscopic approach were included. The majority of our cases were spontaneous leaks. In all our cases we approached the site of defect by an end on approach. All our patients were successfully treated in the first attempt. Endoscopic repair of lateral sphenoid recess has shown better surgical outcome with reduced morbidity.
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Ju SH, Lee DG, Lee JH, Baek MK, Jeong BC, Jeon SS, Lee KS, Han DH. Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty. Korean J Urol 2011; 52:616-21. [PMID: 22025957 PMCID: PMC3198235 DOI: 10.4111/kju.2011.52.9.616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 07/15/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P). Materials and Methods Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting. Results The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months). Conclusions Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.
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Kwak KW, Kim MS, Chang CH, Kim SW, Kim SH. Surgical results of selective median neurotomy for wrist and finger spasticity. J Korean Neurosurg Soc 2011; 50:95-8. [PMID: 22053226 DOI: 10.3340/jkns.2011.50.2.95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 05/12/2011] [Accepted: 08/16/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the surgical outcomes of selective median neurotomy (SMN) for spastic wrist and fingers. METHODS We studied 22 patients with wrist and finger spasticity refractory to optimal oral medication and physical therapy. The authors evaluated spasticity of the wrist and finger muscles by comparing preoperative states with postoperative states using the modified Ashworth scale (MAS). We checked patients for changes in pain according to the visual analog scale (VAS) and degree of satisfaction based on the VAS. RESULTS The preoperative mean MAS score was 3.27±0.46 (mean±SD), and mean MAS scores at 3, 6, and 12 months after surgery were 1.82±0.5, 1.73±0.7, and 1.77±0.81 (mean±SD), respectively. On the last follow-up visit, the mean MAS score measured 1.64±0.9 (mean±SD). Wrist and finger spasticity was significantly decreased at 3, 6, and 12 months after the operation (p<0.01). The preoperative mean pain VAS score was 5.85±1.07 (mean±SD), and the mean pain VAS score on the last follow-up visit after surgery was 2.28±1.8 (mean±SD). Compared with the preoperative mean pain VAS score, postoperative mean pain VAS score was decreased significantly (p<0.01). On the basis of a VAS ranging from 0 to 100, the mean degree of patient satisfaction was 64.09±15.93 (mean±SD, range 30-90). CONCLUSION The authors propose SMN as a possible effective procedure in achieving useful, long-lasting tone and in gaining voluntary movements in spastic wrists and fingers with low morbidity rates.
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Zhang P, Tao KX. Gastric gastrointestinal stromal tumors: an analysis of 114 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:2181-2184. [DOI: 10.11569/wcjd.v19.i20.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical characteristics, diagnosis, treatment and prognosis of gastrointestinal stromal tumors (GISTs) of the stomach.
METHODS: The clinical and pathological data for 114 patients with GISTs of the stomach who were treated from January 2005 to September 2010 at Wuhan Union Hospital were analyzed retrospectively.
RESULTS: GISTs of the stomach were mainly located in the cardia or fundus (53.5%) and the stomach body (36.8%). The common presenting symptoms included gastrointestinal hemorrhage and abdominal pain. EUS and CT had a high accuracy of preoperative diagnosis. Pathological and immunohistochemical examinations were necessary for a clear diagnosis. All but one patient received complete surgical resection. Immunohistochemistry demonstrated that tumor cells were positive for CD117 in 112 cases (98.2%) and for CD34 in 105 cases (92.1%). The follow-up period ranged from 3 to 68 months, with a mean value of 26.2 months. Twenty-four cases received imatinib mesylate after surgery. The 5-year survival rate and tumor-free survival rate were 100% and 98.0%, respectively.
CONCLUSION: Gastric GISTs have atypical clinical features. EUS and CT are effective diagnostic methods. Surgery is the main therapy and targeted therapy can significantly improve the survival of patients with gastric GISTs.
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Zhang ZM, Guo JX, Zhang ZC, Jiang N, Zhang ZY, Pan LJ. Therapeutic options for intermediate-advanced hepatocellular carcinoma. World J Gastroenterol 2011; 17:1685-9. [PMID: 21483627 PMCID: PMC3072631 DOI: 10.3748/wjg.v17.i13.1685] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 01/18/2011] [Accepted: 01/25/2011] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies, ranking the sixth in the world, with 55% of cases occurring in China. Usually, patients with HCC did not present until the late stage of the disease, thus limiting their therapeutic options. Although surgical resection is a potentially curative modality for HCC, most patients with intermediate-advanced HCC are not suitable candidates. The current therapeutic modalities for intermediate-advanced HCC include: (1) surgical procedures, such as radical resection, palliative resection, intraoperative radiofrequency ablation or cryosurgical ablation, intraoperative hepatic artery and portal vein chemotherapeutic pump placement, two-stage hepatectomy and liver transplantation; (2) interventional treatment, such as transcatheter arterial chemoembolization, portal vein embolization and image-guided locoregional therapies; and (3) molecularly targeted therapies. So far, how to choose the therapeutic modalities remains controversial. Surgeons are faced with the challenge of providing the most appropriate treatment for patients with intermediate-advanced HCC. This review focuses on the optional therapeutic modalities for intermediate-advanced HCC.
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Sun CY, Jiang JX. Surgical treatment of hilar cholangiocarcinoma. Shijie Huaren Xiaohua Zazhi 2011; 19:771-776. [DOI: 10.11569/wcjd.v19.i8.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hilar cholangiocarcinoma remains a great challenge for surgeons because of its specific anatomic location and poor prognosis. Radical resection of hilar cholangiocarcinoma is the only possible way to obtain a cure. Currently, there exist many problems and disputes over surgical treatment of hilar cholangiocarcinoma. In this paper, we discuss surgical strategies for managing hilar cholangiocarcinoma.
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Inoue Y, Hayashi M, Hirokawa F, Takeshita A, Tanigawa N. Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy. World J Gastrointest Surg 2011; 3:16-20. [PMID: 21286221 PMCID: PMC3030739 DOI: 10.4240/wjgs.v3.i1.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 09/19/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023] Open
Abstract
A peritoneovenous shunt has become one of the most efficient procedures for intractable ascites due to liver cirrhosis. A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented. A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection. After hepatectomy, a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy, including numerous infusions of albumin and plasma protein fraction and administration of diuretics. Since the patient’s general condition deteriorated, based on the diagnosis of intractable hepatic lymphorrhea, a subcutaneous peritoneovenous shunt was inserted. The patient’s postoperative course was uneventful and the ascites decreased rapidly, with serum total protein and albumin levels and hepatic function improving accordingly. For intractable ascites due to hepatic lymphorrhea after hepatectomy, we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.
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Alaei F, Moghadam MYA, Mortaezaian H, Alaei M, Bakhshandeh H. Balloon Angioplasty versus Surgical Repair of Coarctation of Aorta in Infants. J Tehran Heart Cent 2011; 6:134-7. [PMID: 23074619 PMCID: PMC3466896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 05/17/2011] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Coarctation of the aorta is a discrete stenosis of the proximal thoracic aorta. The common clinical pattern is congestive heart failure in infancy. Treatment methods include balloon angioplasty and surgical repair in this age group. Percutaneous balloon angioplasty is a less invasive method for the repair of discrete coarctation but remains controversial as a primary treatment strategy for a native coarctation. This study aimed to compare the effectiveness and outcome of balloon angioplasty and surgical repair in coarctation infants younger than 1 year old. METHODS This retrospective study evaluated the results of the two methods in 167 patients younger than one year old admitted into a tertiary heart center pediatric ward with the diagnosis of coarctation of the aorta: Balloon angioplasty was done for 55 and surgical repair for 112 infants. Patients with previous interventions were not included in this study. RESULTS Primary results revealed no significant difference in the effectiveness of the two methods (p value = 0.0601). While the rate of recurrent coarctation was significantly lower in the surgery group [19 (17%) vs. 11 (20%), p value = 0.0470], the mortality rate was lower in the balloon angioplasty method [5 (5.5%) vs. 13 (11.6%), p value = 0.039]. Our multivariate logistic regression model, however, showed no statistically significant difference (p value = 0.120). CONCLUSION Because of the incidence of re-coarctation, balloon angioplasty compared with surgical repair did not confer an improved outcome for our infants' coarctation.
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Zheng YZ, Wang D, Li ZS. Progress in clinical application of natural orifice transluminal endoscopic surgery. Shijie Huaren Xiaohua Zazhi 2010; 18:3539-3543. [DOI: 10.11569/wcjd.v18.i33.3539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Natural orifice transluminal endoscopic surgery (NOTES) is a new minimally invasive technique that involves accessing body cavity organs via natural orifices (stomach, colon or vagina) to perform intra-abdominal surgical procedures. On the basis of previous animal experiments, NOTES has been gradually applied in clinical practice around the world. This paper aims to review the progress in clinical application of NOTES.
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171
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Shin DK, Jung YJ, Hong JC, Kim MS, Kim SH. Selective musculocutaneous neurotomy for spastic elbow. J Korean Neurosurg Soc 2010; 48:236-9. [PMID: 21082051 DOI: 10.3340/jkns.2010.48.3.236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/30/2010] [Accepted: 09/15/2010] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness and outcome of selective musculocutaneous neurotomy (SMcN) for spastic elbow. METHODS We retrospectively reviewed the medical records of 14 patients with spasticity of their elbows. The patients were selected using clinical and analytical scales, as well as nerve block tests, for assessment. Their mean age was 37.29 years (range, 19-63 years). SMcN was performed for these patients, and the mean follow-up period was 30.71 months (range, 19-54 months). RESULTS The modified Ashworth scale (MAS) scores recorded before and after the SMcN showed that the patients' mean preoperative MAS score of 3.28 ± 0.12 was improved to 1.71 ± 0.12, 1.78 ± 0.18, 1.92 ± 0.16 and 1.78 ± 0.18 at postoperative 3, 6, 12 months and last follow-up, respectively. On the basis of a visual analogue score ranging from 0-100, the patients' mean degree of satisfaction score was 65.00 ± 16.52 (range, 30-90). CONCLUSION We believe that SMcN can be a good and effective treatment modality with low morbidity in appropriately selected patients who have localized spastic elbow with good antagonist muscles and without joint contracture.
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172
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Rao JB, Jeevan Kumar KA, Kumar BP. Glandular odontogenic cyst involving the posterior part of maxillary sinus, a rare entity. J Maxillofac Oral Surg 2010; 9:72-5. [PMID: 23139573 DOI: 10.1007/s12663-010-0020-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 02/19/2010] [Indexed: 10/19/2022] Open
Abstract
The Glandular Odontogenic Cyst (GOC) was first coined by Gardner et al. [2], in 1988 as an odontogenic origin, is a rare developmental lesion considered a distinct entity because of its uncommon clinical and histopathological characteristics. This lesion can involve either jaws, but the anterior region of the mandible is the most affected area. It strikes distinct age groups, with an average patient age of 50 years. Radiographically, GOC does not display specific or pathognomonic features. It may present as a multilocular or unilocular radiolucencies. The cyst has an aggressive nature and high tendency of recurrence, so long-term follow-up should be carried out. The treatment is controversial, varying from conservative methods to block excision. It is believed that the low prevalence of GOC in the literature is because of not only its rarity, but principally to the fact that its main characteristics are also found in other pathological entities, thereby generating controversial diagnoses. The aim of this paper is to present a rare case of Glandular Odontogenic Cyst (GOC), which is uncommon in the posterior maxilla, that mimicks the lateral odontogenic cyst/botroid odontogenic cyst/Central Muco-epidermoid carcinoma. Owing to its tendency to recur, the lesion needs careful and meticulous planning for its surgical removal.
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Uchimoto K, Koyama F, Fujii H, Nakagawa T, Ohtsuki K, Nakamura S, Ueda T, Enomoto Y, Nonomura A, Nakajima Y. Sigmoidectomy for radiation-induced sigmoid colonic dysplasia 35 years after radiotherapy for cervical cancer. Clin J Gastroenterol 2009; 2:412-416. [PMID: 26192797 DOI: 10.1007/s12328-009-0120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 10/07/2009] [Indexed: 11/25/2022]
Abstract
Although radiation-induced colonic cancer is thought to arise from dysplasia, no guidelines exist for the treatment of such dysplasia. Therefore, clinicians must make treatment decisions for this condition on a case-by-case basis. Especially when the operative procedure is being decided, it is necessary to consider postoperative quality of life for advanced age. We report a patient who underwent sigmoidectomy for sigmoid colonic dysplasia that developed 35 years after radiation therapy. A 73-year-old woman who had undergone total hysterectomy and chemoradiotherapy for cervical cancer 35 years previously presented following a positive fecal occult blood test. Colonoscopy revealed sigmoid colonic dysplasia. To ensure reliable removal of the lesion, we elected to perform surgical resection. Given the patient's age, we performed sigmoidectomy rather than resecting the entire irradiated intestinal tract. The diagnosis of dysplasia was confirmed based on pathological findings, which included duct proliferation with partial structural atypia.
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174
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Stieve M, Kempf HG, Lenarz T. Management of choanal atresia in cases of craniofacial malformation. J Maxillofac Oral Surg 2009; 8:52-4. [PMID: 23139471 DOI: 10.1007/s12663-009-0013-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 02/08/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report the method and results of endonasal endoscopic approach in congenital choanal atresia in cases of craniofacial malformation. PATIENTS The pathology of unilateral and bilateral choanal atresia and the treatment results in seven children treated between 1999 and 2006 are presented. 5 infants suffering from bilateral atresia also had severe malformations (Charge syndrome [2 patients], trisomy 18, microcephalus, central cranioschisis, cleft lip and anophthalmia 9). The surgical intervention was carried out immediately after birth. 2 patients with unilateral atresia were treated in their second and sixth year of life respectively. CT scan was the diagnostic procedure of choice. Intraoperative endoscopy showed both membraneous and osseous atresia. SURGICAL PROCEDURE Trocars of different sizes were used to open the atresia plate, while the osseous parts were removed with diamond drills. Silicone tubes were inserted transnasally and remained in place for several months to improve the infants'ability to breath and drink. RESULTS In all cases of bilateral atresia the tubes either had to be changed repeatedly or replaced with larger tubes due to dislocation and head growth. The septum was perforated in one case. No further stenoses were detected following the removal of the tubes (after 3-6 months). CONCLUSION The transnasal access is particularly suited to newborns and infants because it induces a minor surgical trauma and carries a low risk of bleeding if endoscopes are used. The results show that the risk of restenoses can be minimised with sufficient fixating and in-patient care.
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Xu YH, Guo KJ, Guo RX, Ge CL, Tian YL, He SG. Surgical management of 143 patients with adult primary retroperitoneal tumor. World J Gastroenterol 2007; 13:2619-21. [PMID: 17552013 PMCID: PMC4146826 DOI: 10.3748/wjg.v13.i18.2619] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the surgical management of adult primary retroperitoneal tumors (APRT) and the factors influencing the outcome after operation.
METHODS: Data of 143 cases of APRT from 1990 to 2003 in the First Affiliated Hospital of China Medical University were evaluated retrospectively.
RESULTS: A total of 143 cases of APRT were treated surgically. Among them, 122 (85.3%) underwent complete resection, 16 (11.2%) incomplete resection, and 3 (3%) surgical biopsies. Twenty-nine (20.2%) underwent tumor resection plus multiple organ resections. Ninety-five malignant cases were followed up for 1 mo to 5 years. The 1-year, 3-year, and 5-year survival rates of the patients subject to complete resection was 94.9%, 76.6% and 34.3% and that of patients with incomplete resection was 80.4%, 6.7%, and 0%, respectively (P < 0.001). The Cox multi-various regression analysis showed the completeness of tumor, sex and histological type were associated closely with local recurrence.
CONCLUSION: Sufficient preoperative preparation and complete tumor resection play important roles in reducing recurrence and improving survival.
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