Use of a navigation system in endonasal surgery: Impact on surgical strategy and surgeon satisfaction. A prospective multicenter study

OBJECTIVES

Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study.

MATERIALS AND METHODS

A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure.

RESULTS

The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases.

CONCLUSION

In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

Pharmacological evidence for the role of RAR in axon guidance and embryonic development of a protostome species

Retinoic acid (RA), the active metabolite of vitamin A, functions through nuclear receptors, one of which is the retinoic acid receptor (RAR). Though the RAR is essential for various aspects of vertebrate development, little is known about the role of RAR in nonchordate invertebrates. Here, we examined the potential role of an invertebrate RAR in mediating chemotropic effects of retinoic acid. The RAR of the protostome Lymnaea stagnalis is present in the growth cones of regenerating cultured motorneurons, and a synthetic RAR agonist (EC23), was able to mimic the effects of retinoic acid in inducing growth cone turning. We also examined the ability of the natural retinoids, all-trans RA and 9-cis RA, as well as the synthetic RAR agonists, to disrupt embryonic development in Lymnaea. Developmental defects included delays in embryo hatching, arrested eye, and shell development, as well as more severe abnormalities such as halted development. Developmental defects induced by some (but not all) synthetic RAR agonists were found to mimic those induced by addition of high concentrations of the natural retinoid isomers. These pharmacological data support a possible physiological role for the RAR in axon guidance and embryonic development of an invertebrate protostome species.

Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynaecology colleagues is essential as operative intervention is often required.

Treatment of hepatitis C virus infection in patients on maintenance hemodialysis: a single United Arab Emirates center experience

BACKGROUND

Hepatitis C is prevalent among hemodialysis patients. In patients with normal kidney function, treatment with pegylated interferon and ribavirin can lead to eradication of HCV (hepatitis C virus). But the treatment is more problematic in patients with impaired kidney function, in part due to the altered pharmacokinetics of these medications. Despite recent guidelines, the optimal strategy in this group of patients is not well defined.

METHOD

In a retrospective study, we reviewed all patients with chronic hepatitis C on hemodialysis treated at Sheikh Khalifa Medical City, in the United Arab Emirates between 2003 and 2009. The aim of our study was to determine the rate of sustained viral response (SVR) and to establish the safety and rate of dropouts in the different treatment regimens used (patients treated with peginterferon only and patients treated with peginterferon and low dose ribavirin).

RESULTS

22 patients were treated during this period. 5 patients received monotherapy with a reduced dose of peginterferon alfa 2b s.c. once weekly while 17 patients were treated with a combination of reduced dose of peginterferon alfa 2a or 2b s.c. once weekly and a low dose ribavirin (200mg/day). A SVR was achieved in 73% (16/22 patients) of the total patient population and in 76% (13/17 patients) in the sub-group of patients treated with a combination therapy. The tolerability was high. No patients had to discontinue their treatment. The use of ESA (erythropoietin stimulating agents) and G-CSF was common in the combination therapy (94% and 53% respectively).

CONCLUSION

In our study of patients on hemodialysis with chronic hepatitis C, the use of peginterferon or a combination of peginterferon with a low daily dose of ribavirin achieved a high rate of SVR and the rate of dropout was low after pursuing an aggressive management of side effects.

[Lips reanimation with temporalis myoplasty technique]

PURPOSE OF THE STUDY

The authors report their experience in lips reanimation with lengthening temporalis myoplasty for treatment of facial paralysis.

MATERIALS AND METHODS

We studied 8 patients with permanent facial paralysis. The surgical technique allowed to transfer temporalis tendinous of coronoid process onto lips muscular strap, without aponevrotic relay.

RESULTS

Functional and aesthetic results are exposed and so complications. Specialized facial physiotherapy rehabilitation is necessary in order to improve.

[Ethmoid adenocarcinoma: a series of 17 cases]

INTRODUCTION

Ethmoid adenocarcinoma are and represent rare, 2.5 to 3% of head and neck cancers. The 5-year survival is around 50% for all stages. We present a series of 17 patients treated in our institution.

OBJECTIVES

Expose the treatment of these patients and evaluate the results.

METHODS

A retrospective study of 17 consecutive patients, treated between 1992 and 1999 for an ethmoid adenocarcinoma (15 T4 and 2 T2) and evaluated in 2002, with a mean follow-up of 5.8 years.

RESULTS

In May 2002, 4 (23.53%) patients were alive and disease-free, 3 (17.65%) were alive with recurrence and 10 (58.82%) was died. The 5-year survival with Kaplan Meyer method is 41%.

CONCLUSION

This series demonstrates the contribution of a combined approach for T3 and T4 tumors. The bifrontal approach induced an important morbidity in our series and should be replaced by the nasofrontal approach. Most teams agree that postoperative radiotherapy is necessary but the appropriateness of chemotherapy is still discussed. Some authors are of the opinion that it has no action on adenocarcinoma and others that it improves survival. It seems to have been efficient in our T4 patients.

[Acoustic comparison of esophageal versus tracheoesophageal speech]

The authors present results of an acoustic criterions analysis made next to 57 subjects, who had undergone total laryngectomy or total pharyngolaryngectomy, between 6 months and 3 years before. The study allows to assess, next to 29 tracheoesophageal voices and 30 oesophageal voices, the fundamental frequency, the vocal extensive, the maximum phonation time, and the study of pauses (number and time) in a reference sentence. The acoustic advantages of phonatory prothesis are confirmed, but the oesophageal voice knowledge must not be forgotten.

Hypercalcemia due to parathyroid adenoma

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[Our experience on Rendu-Osler disease. Apropos of 19 cases]

We report a synthesis of our experience about the Osler-Weber-Rendu disease, based on a retrospective study of 19 cases collected from 1978 to 1995. Except the almost systematic recourse to anterior or posterior packings in 31% of cases, management of epistaxis in urgency has consisted of arteriography with embolization of the maxillary arteries. In this way, in two third of cases, the control of the epistaxis was obtained. In the other third, it was necessary to associate arteriography to a ligature of the ethmoidal arteries. As part of a preventive treatment of epistaxis we prefer, presently, to inject in situ a fibrin glue, which can be reviewed at the demand. These injections bring only exceptionally complications. The quality and duration of remission is judged satisfactory by the patients in 80% of the cases. Although no physio-pathological explanation can be brought, the intramuscular injections of fibrin glue could increase the duration of remission, which in this way, could diminish the frequency of injections in situ.

[Role of super selective arteriography with embolization in the treatment of severe epistaxis: our experience apropos of 16 cases]

Diagnostic angiography and super selective embolization of the internal maxillary artery were performed on 16 cases between 1990 and 1995. The patients (mean age, 49 years) were treated for severe posterior epistaxis, refractory to local haemostatic therapy (nasal packing alone for the most of them), hypertension was found to be the most frequent predisposing factor, 13 patients had their nose bleeding stopped. Among the 3 failures, were 2 cases of Osler-Weber-Rendu disease, which were subsequently significatively improved by this method. We conclude that angiography with super selective embolization is considered as a valuable diagnostic and therapeutic option in the management of patients with severe epistaxis.