Surgical Treatment Research Papers - Academia.edu (original) (raw)

Endometriosis is a painful disorder defined by extrauteral endometrial growths whose contribution to pain symptoms is poorly understood. Endometriosis is created in rats by autotransplanting on abdominal arteries pieces of either uterus (ENDO), which form cysts, or fat (shamENDO), which do not form cysts. ENDO, but not shamENDO induces vaginal hyperalgesia. We tested the hypothesis that the cysts are necessary to maintain vaginal hyperalgesia by assessing the effect of surgically removing them. Complete cyst removal eliminated ENDO-induced vaginal hyperalgesia up to four months post-operatively. Sham-cyst-removal in ENDO rats, in which cysts were not removed, or partial cyst-removal increased the ENDO-induced hyperalgesia. The decreases and increases both took three to six weeks to develop. Changes in ENDO-induced hyperalgesia did not occur in a control group of ENDO rats who had no surgery after ENDO. In a double-surgery control group, neither shamENDO surgery nor a subsequent sham surgery that mimicked "removal" of non-existent cysts influenced vaginal nociception. In a no-surgery control group, vaginal nociception remained stable for > six months. The increases in ENDO-induced hyperalgesia produced by the sham-cyst-removal surgery were smaller in proestrus than in other estrous stages. During the other stages (but not during proestrus), sympathetic innervation of the cysts increased. These results suggest that maintenance of ENDO-induced vaginal hyperalgesia requires continued presence of at least some ectopic endometrial tissue, and that surgical treatment that fails to remove ectopic endometrial tissue can exacerbate the hyperalgesia, possibly due in part to an increase in the cysts' sympathetic innervation.

- by
- •
- Pain, Menopause, Rats, Endometriosis

Background-Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis. Aims-To analyse the clinical value of PCT and IL-8 as biochemical parameters for predicting infected necrosis in acute pancreatitis. Patients and methods-Fifty patients with acute pancreatitis entered this prospective study and were stratified into three groups according to morphological and bacteriological findings: 18 patients with oedematous pancreatitis (group I), 14 patients with sterile necrosis (group II), and 18 patients who developed infected necrosis a median of 13.5 days after the onset of symptoms (group III). After admission serum samples were drawn daily for two weeks. Concentrations of PCT and IL-8 were measured by chemoluminescent immunoassays (upper reference range 0.5 ng/ml for PCT and 70 pg/ml for IL-8).

- by Jens Mayer
- •
- Nonparametric Statistics, Adolescent, Prospective studies, Course Management Systems
- by Alan Meyers
- •
- Bariatric Surgery, Patient Safety, Evidence Based Medicine, Obesity
- by Alessandro Fichera
- •
- Clinical Sciences, Minimally Invasive, Crohn Disease, Surgical Treatment

PRIMARY AORTOENTERIC FISTULA. REPORT OF A CASE Primary aortoenteric fistulas (PAEF) are rare entities asso - ciated with a high mortality. Although several causes have been reported, their occurrence is usually due to erosion of an abdominal aortic aneurysm into the intestinal tract. The most common sites for the fistula are the third and fourth portions of duodenum. The classical triad of gastrointesti - nal hemorrhage, abdominal mass and abdominal or back pain, though highly suggestive for PAEF, is uncommon. The typical bleeding pattern associated with PAEF is characte - ristically intermittent, starting with a brief "herald blee - ding" followed eventually by major gastrointestinal hemor- rhage, often with fatal outcome. The pre-operative exami - nations are often not helpful and can lead to delayed dia - gnosis and surgery. In a patient with risk factors for athe - rosclerosis and significant upper gastrointestinal bleeding in the absence of an evident source, PAEF sho...

- by Claudio Feo
- •
- Back Pain, Risk factors, Risk Factors, Abdominal Aortic Aneurysm

SUMMARY The authors compare their experience with the treatment of pelvic ring injuries with the literature data concerning the etiology, diagnosis and classification of this trauma, co-existing pathologies, primary therapeutic procedures, timing of the definitive treatment, surgical approaches, osteosynthesis of the posterior and anterior segments, complications and las- ting sequelae. The authors regard the issue of surgical treatment as an

- by Valér Džupa
- •
- Medicine, Surgical Treatment

Lesioning or chronic deep brain stimulation (DBS) of the nucleus ventralis intermedius results in abolition of tremor in the contralateral limbs in Parkinson's disease (PD) and also in essential tremor. Recently, chronic DBS of the subthalamic nucleus has also proved to be very effective in reducing contralateral limb tremor in PD. These targets have been less effective in controlling the complex limb tremor often seen in multiple sclerosis (MS). Consequently, other targets have been sought in cases of MS with tremor. We describe a patient with MS with disabling proximal and distal involuntary arm movements in whom we were able to obtain sustained control of contralateral arm tremor and achieve functional improvement of the affected arm by chronic DBS of the region of the zona incerta. We also highlight the important role played by local field potentials recorded from the brain, with simultaneous recording of corresponding EMGs, in target localisation.

With the global pandemic of hepatitis B and C infections, the incidence of Hepatocellular carcinoma (HCC) is rapidly increasing world wide. We identified glypican-3 (GPC3), a novel oncofetal gene over-expressed specifically in human HCC, as based on data of cDNA microarrays. As GPC3 is a GPI-anchored membrane protein and could be secreted, we attempted to detect secreted GPC3 protein in sera from HCC patients using Western blotting and ELISA. GPC3 protein was positive in sera of 40.0% (16/40) of HCC patients, and negative in sera from subjects with liver cirrhosis (LC) (0/13), chronic hepatitis (CH) (0/34), and healthy donors (0/60). All subjects were Japanese. Although 12 of 40 HCC patients were negative for both a-fetoprotein (AFP) and PIVKA-II well known tumor markers of HCC, four of these were GPC3-positive in the sera. We also observed vanishing GPC3 protein in the sera of three patients after the surgical treatment for HCC. On the other hand, immunohistochemical analysis revealed that HCC expressed GPC3 protein in all 14 HCC patients tested. In conclusion, GPC3, as defined in this study was shown to be a useful tumor marker for cancer-diagnosis for large numbers of patients with HCC.

- by Hiroshi Ashihara
- •
- Immunohistochemistry, Gene expression, Hepatitis B, Liver Cirrhosis

Surgical resection and chemotherapy are the mainstay of the treatment for undifferentiated embryonal sarcoma of the liver. Whether neoadjuvant chemotherapy should be systematically performed is a matter of debate; perioperative morbidity and mortality should be carefully weighed against chemotherapy-associated complications. In order to manage undifferentiated embryonal sarcoma of the liver and to allow for accurate outcome analysis, there is a clear need for standardization of disease extent as well as for a risk stratification system, including the PRETEXT grouping system, patient age, and tumor size.

- by Hepatoma Research and +1
- •
- Pediatrics, Liver diseases, Gastroentrology & Hepatology, Liver Cancers

The purpose of this study was to develop a Portuguese version of the Epilepsy Surgery Inventory (ESI-55) and to assess its psychometric properties. Sixty patients with temporal lobe epilepsy related to unilateral mesial temporal sclerosis who underwent presurgical evaluation at the Universidade Federal de São Paulo (UNIFESP) formed the sample for this study. The psychometric properties of the ESI-55 included: reliability, validity, and responsiveness. Internal consistency was high in all domains (Cronbach's a ranging from 0.76 for Social Function to 0.88 for Physical Function) except Overall Quality of Life (a = 0.45). Test-retest reliability after 1 week was good, with the intraclass correlation coefficient ranging from 0.79 (Energy/Fatigue) to 0.92 (Role Limitations due to Emotional Problems). Interrater reliability ranged from 0.84 (Cognitive Function) to 0.94 (Role Limitations due to Physical Problems). For construct validity, we verified a high correlation between the ESI-55 and Health Assessment Questionnaire-8 for the Physical Function domain (Pearson linear correlation = À0.84), and a moderate correlation for the Pain domain (P = À0.58), but for the other subscales no correlation was detected. Beck Depression Inventory and ESI-55 domains were highly statistically correlated (ANOVA: P < 0.005), but there was no association of the Cognitive Function and Role Limitations due to Memory Problems subscales with neuropsychological evaluation (Pearson coefficient: P > 0.05). With respect to demographic characteristics, a statistically significant correlation was observed for the variable educational level (Student t, P < 0.005) and ESI-55 scores. There was a high correlation between seizure frequency and ESI-55 domains for clinical variables (ANOVA, P < 0.005). Surgical treatment in this series improved health-related quality of life in the seizure-free group in three domains-Health Perception (1.24), Emotional Well-Being (1.32), and Energy/Fatigue (1.48)-as reflected by the standard response mean and the effect size of the sample. Our results support the psychometric properties of the Portuguese version of the ESI-55 as a measure of health-related quality of life.

- by Ana Carolina Azevedo
- •
- Psychometrics, Quality of life, Brazil, Language
- by Nozar Aghakhani
- •
- Neurosurgery, Treatment Outcome, Adolescent, TIME

Background Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD), which are chronic inflammatory conditions affecting the gastrointestinal tract. There are only few published data on disease characteristics of IBD related to South Asia. Objective To provide the disease characteristics of the IBD patients who presented to a tertiary care hospital in South Asia. Methods Patients with an established diagnosis of IBD were identified after a review of their medical records and demographics, and disease characteristics and indications for surgical treatment were analyzed. Results A total of 184 patients (women=101, 54.9%; UC=153, 83.2%) were included. Female preponderance was observed for UC (male/female ratio =1:1.5) and male for CD (male/female=2:1). Mean age at the time of diagnosis was 36.3 (range 7-71) years. CD was diagnosed at a significantly younger age than UC (27.35±10.22 vs. 38.14±13.05 years, p<0.0001). CD showed a peak age of onset in the third decade and that for UC was in the fourth decade. The mean duration of IBD was 8.17 (range 1-28) years. Presenting complaint of the majority (73.7%) of UC patients was blood and mucous diarrhea and that for CD (77.4%, 24/31) was left-sided abdominal pain. Only 9.5% (n=18) had at least one extra-intestinal manifestation. Among UC patients, 51.7% (n=79) had left-sided colitis and panproctocolitis was found in 18.3% (n=28). In IBD patients, 14.1% (n=26) underwent surgery. Only one patient developed malignancy. Conclusions The majority of UC patients had left-sided colitis. CD compared to UC was diagnosed at a younger age. However, compared to data reported for some Western countries, extra-intestinal manifestations and malignancy rates were lower.

- by Duminda Subasinghe
- •
- South Asia, Sri Lanka, Adolescent, Diarrhea

The maximum and mean values of the resting UES pressure and the length of the resting UES pressure in NSF, HSS, and HOS were 55.8}20.0 (mmHg, mean}standard deviation), 138.5}79.1, 28.9}15.0, and 32.3}9.2, 56.8}23.5, 17.8}5.9, and 3.6}0.7 (cm), 3.8}0.7, 2.4}1.0, respectively. The maximum and mean values of the resting UES pressure in HSS and HOS were statistically higher and lower than those in NSF, respectively. The length of the resting UES pressure in HOS was statistically shorter than that in NSF.

Objective: despite recent advances in medical imaging, pre-operative evaluation of liver tumors, whether benign or malignant, is often lacking in accuracy and precision. With the development of surgical laparoscopy, the benefits of diagnostic laparoscopy have been combined with those of operative ultrasound. This article aims to describe the technique of laparoscopic ultrasound of the liver, and to define its applications

- by Jean-marc Catheline
- •
- Ultrasound, Biopsy, Ultrasonography, Medical Image

Thyroid cancer (TC), comprising less than 1% of all cancers in the Netherlands, has a good prognosis in general. Controversy still remains on the extent of surgical treatment and the indication for additional Iodine-131 (131I) therapy in the management of differentiated TC. The aim of this study was to describe (changes in) the treatment of TC and to determine independent

- by Harm Haak
- •
- Thyroid Cancer, Survival Rate, Retrospective Study, Cancer Registry
- by Marcelo Fajardo and +1
- •
- Medicine, Clinical Sciences, Type 2 Diabetes Mellitus, Surgical Treatment

Controversy still exists about the optimal surgical treatment of rectal cancer. The main purpose of the present study was to compare local recurrence (LR) rates after mesorectal excision (ME) and conventional surgery (CS) technique. Methods: All rectal cancer patients from a defined catchment area were included. Outcome after ME in the period 1993-1999 (n=161) was compared with the outcome after CS (n=217) in the period 1983-1992. Partial ME (PME) was the routine in upper, and total ME the routine in mid-and low rectal cancer. The follow-up programmes were identical, and the median observation times very similar (37 and 38 months) in the two periods. Five-year actuarial LR rate and survival were estimated using the Kaplan-Meier method, and adjustment for prognostic factors was performed with Cox regression analysis. Results: Total LR rate after R0 resection was 7.7% crude and 9% 5 year actuarial in the ME period, as compared with 16.0% crude and 24% actuarial in the CS period (P=0.02). Cox regression analyses confirmed these differences with a hazard ratio of 0.40 for ME vs CS (P=0.02). Isolated LR rate was 2% after ME and 8% after CS. Five-year actuarial total LR rate after rectal resection with curative intent was 11% after ME and 27% after CS (P<0.01). Actuarial total LR rate after PME was 6%, and none of these patients developed isolated LR. Conclusion: Standardization of surgical technique and application of ME resulted in a significant reduction of LRs. LR rate was low after PME, indicating that this procedure is adequate in upper rectal cancer.

- by Ola Westerheim
- •
- Treatment Outcome, Prospective studies, Cox Regression, Follow-up studies

Background and Purpose-The rarity of spinal dural arteriovenous fistulae makes physicians often overlook this potential diagnosis in patients with progressive gait disturbance and paraparesis. Consequently, patients with spinal dural arteriovenous fistulae can gradually become completely paraplegic if the final diagnosis is delayed considerably. The objective of the current study is to demonstrate that, particularly in patients with paraplegia, surgical treatment of fistula is necessary and often has a favorable outcome. Methods-Of 42 patients with spinal dural arteriovenous fistulae treated in our institution (surgery or endovascular treatment), 6 were paraplegic preoperatively (Grade IV on the McCormick scale and Grade V on the Aminoff scale, Grade 5 of modified Rankin Scale with motor ASIA between 0 and 10 for both lower limbs). Their clinical history revealed that paraplegia appeared progressively within a period of Ͻ3 months. All patients were clinically evaluated at 6 weeks, 6 months, and then annually during an average follow-up of 3 years. Patients received at least one spinal angiography and MRI test during the follow-up period.

- by Nozar Aghakhani
- •
- Stroke, Paraplegia, Spinal Cord, Clinical Sciences

Objective: Though the surgical treatment of esophageal cancer is increasingly accepted for elderly people defined as aged over 70 years, less is reported about the results in patients over 75. This study is a single institution retrospective analysis of outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Methods: All consecutive patients 76 years old and over undergoing curative esophagectomy for cancer in the period 1991-2006 were analyzed as to comorbidities, outcome and long-term survival. All the data had been prospectively collected in a database. Postoperative mortality risk was assessed by P-POSSUM and O-POSSUM score for in-hospital mortality and by the recently published Steyerberg's score system [Steyerberg EW, Neville BA, Koppert LB, Lemmens VEPP, Tilanus HW, Coebergh JWW, Weeks JC, Earle CC. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277-84.] for 30-day mortality. Five-year survival was compared to the standardized survival in the general population. Results: One hundred and eight patients fulfilling the abovementioned criteria were found (76 males and 32 females, mean age 79.5 years, mean standardized life-expectancy: 7.36 years). Among them, 69% had esophageal tumors and 31% GEJ tumors. The predominant histology was adenocarcinoma (74%). Eighty-six (79.6%) presented with one or more major comorbidities or a history of previous major upper-GI surgery, potentially affecting the surgical outcome. All underwent resection with curative intent (R 0 83.3%, R 1 12%, R 2 4.6%). The overall postoperative morbidity rate was 51.9%, pulmonary complications (37%) being the most frequent. Postoperative mortality, mainly due to cardiopulmonary complications, was 7.4%, which was consistent with that predicted by P-POSSUM score (7.2%) and lower than that predicted by O-POSSUM score (15.1%). Thirty-day mortality was 5.5%, being consistent with that predicted by the Steyerberg's score (6.8%). Overall 5-year survival was 35.7%, while R 0 overall survival 42% and cancer specific R 0 survival 51.7%. Conclusions: Patients 76 years old and over with esophageal or GEJ cancer should not be denied surgery solely on the basis of age. Outcome and long-term results in the selected elderly are not differing from those reported for younger patients. However, despite thorough preoperative assessment being applied in the selection of the candidates for surgery, a practical and reliable individual riskanalysis stratification is still lacking. #

- by Paul Leyn and +2
- •
- Treatment Outcome, Stratification, Risk Analysis, Elderly People

Among 4608 patients with gastric carcinoma treated during a 20-year period from 1971 to 1990, 328 (7.1%) were less than 40 years of age. The clinicopathologic features and treatment results in this young group were compared with those for older gastric carcinoma patients (40-79 years of age, control group). In the young group, the male/female ratio and the prevalence of

- by Mitsuru Sasako
- •
- Young Adult, Survival Rate, Prognosis, Age Factors

Tracheal adenoid cystic carcinoma which is an uncommon tracheal malignancy may manifest an atypical clinical course. In case of tracheal localisation, despite technical difficulties, it shouldn't be avoided from surgical treatment. We present an uncommon surgical procedure performed to our patient with tracheal adenoid cystic carcinoma in whom a slow clinical course and a good prognosis occured, despite positive resection margin after surgical treatment.

- by Funda Demirag
- •
- Case Report, Adenoid cystic carcinoma, Surgical Treatment

Radiation proctitis is a well-known complication of abdominal and pelvic radiation. Conventional medical and surgical treatment often is disappointing. 5-Aminosalicylic Acid (5-ASA) is the active component in sulfasalazine and is effective in the treatment of distal ulcerative colitis. Four patients with radiation proctitis were treated with 4 g 5-ASA by enema nightly for two to six months. Patients were seen monthly, interviewed, and a sigmoidoscopic exam performed. No change was seen in the degree of mucosal inflammation on foUow-up sigmoidoscopic exams. Three patients noted no change in their symptoms of bleeding, pain, or tenesmus. One patient noted initial improvement, but this was not sustained. 5-ASA enemas do not appear to be effective in the treatment of radiation proctitis.

- by Wendy Biddle
- •
- Ulcerative colitis, Chronic Disease, Clinical Sciences, Radiation Injuries

Objective To assess clinical status, changes in health related quality of life, and subsequent management five years after medical management or transcervical resection of the endometrium for treatment of heavy menstrual loss. Design Five... more

- by Sean Duffy
- •
- Quality of life, Survival Analysis, Treatment Outcome, Health related Quality of Life

Cardiac papillary fibroelastoma is a rare benign tumor that can cause thromboembolism. We have found no large surgical series describing its treatment and outcome. A retrospective review of all patients treated surgically for this tumor from 1985 to 2002. There were 88 patients with a mean age of 62 +/- 16 years. Sixty-two (71%) were male. Cardiac papillary fibroelastoma was a primary indication for surgery in 47 (group 1, 53%) and an incidental finding in 41 (group 2, 47%). The common clinical symptoms were neurologic (group 1) and cardiac (group 2). Cardiac valves were predominantly involved (77%); the aortic valve was the most affected (52%). Other common sites were the left ventricular outflow tract (18%) and anterior mitral leaflet (11%). All heart valves were involved in one patient. Seventy-three patients (83%) had shave excision and 8 (9%) excision with valve repair. Of 5 (6%) valve replacements, 2 were for concurrent degenerative valve disease. Concomitant procedures included repair or replacement of another valve (32%), CABG (28%), and septal myectomy (19%). Surgical mortality occurred in 1 patient (2.1%) in group 1 who had concomitant lung resection for bronchiolitis obliterans. There was no tumor recurrence, and no tumor-related late morbidity or mortality at a mean follow-up of 3 years. Cardiac papillary fibroelastoma has a propensity to affect the anatomically contiguous structures of the aortic valve, left ventricular outflow tract, and anterior mitral leaflet. Surgical treatment by simple shave excision is low risk and can achieve good results.

- by Joseph Dearani
- •
- Clinical Sciences, Aged, Retrospective Studies, Surgical Treatment

Purpose of study To determine the efficacy of Nd:YAG vitreolysis and pars plana vitrectomy in the treatment of vitreous floaters. Methods This is a single centre retrospective study of 31 patients (42 eyes) who underwent 54 procedures, Nd:YAG vitreolysis or pars plana vitrectomy, for the treatment of vitreous floaters between January 1992 and December 2000. Main outcome measures were percentage symptomatic improvement following treatment and incidence of post-operative complications. Statistical analysis was performed using the Fisher exact test. Results Posterior vitreous detachment was the primary cause of floaters in all 42 eyes with co-existing vitreous veils in three eyes and asteroid hyalosis in two eyes. Thirtynine of 42 eyes received Nd:YAG vitreolysis. Thirty-eight percent found Nd:YAG vitreolysis moderately improved their symptoms while 61.5% found no improvement. After an average of 14.7 months follow-up no post-operative complications were recorded. Fifteen eyes underwent a pars plana vitrectomy, one with combined phacoemulsification and posterior chamber implantation and 11 following unsuccessful laser vitreolysis. Pars plana vitrectomy resulted in full resolution of symptoms in 93.3% of eyes. One patient developed a post-operative retinal detachment which was successfully treated leaving the patient with 6/5 VA. Conclusion Patients' symptoms from vitreous floaters are often underestimated resulting in no intervention. This paper shows Nd:YAG vitreolysis to be a safe but only moderately effective primary treatment conferring clinical benefit in one third of patients. Pars plana vitrectomy, while offering superior results, should be reserved for patients who remain markedly symptomatic following vitreolysis, until future studies further clarify its role in the treatment of patients with floaters and posterior vitreous detachment.

- by Yvonne Delaney
- •
- Immunology, Statistical Analysis, Treatment Outcome, Retinal detachment

Safety and efficiency of ambulatory treatment of acute diverticulitis Abstract Introduction: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management. Objective: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients. Methods: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3 cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7-10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month. Results: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery. Conclusions: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs.

- by Andres Reyes Marin
- •
- Gastroenterology, Efficiency, Conservation Management, Surgical Treatment

The long-term outcomes of 25 patients with childhood moyamoya disease (18 with the transient ischemic attack [TIA] type and seven with the non-TIA type), who were monitored to adulthood (older than 20 years of age), were evaluated in terms of residual clinical symptoms, intellectual development, and activities of daily living. Surgical treatment was performed in ten patients, encephaloduroarteriosynangiosis in nine, and superficial temporal artery to middle cerebral artery anastomosis plus encephalomyosynangiosis in one. Only seven with the TIA type (three surgically and four medically treated) demonstrated good activities of daily living without TIA or headache and normal IQ. Two patients with the TIA type and three with the non-TIA type demonstrated poor outcomes. Three of these patients with poor outcomes had renal artery stenosis. Surgery was effective in nine. Since the longterm outcomes of patients with childhood moyamoya disease are generally poor, surgical treatment is believed to be an effective procedure for preventing the progression of clinical symptoms. © 1998 by Elsevier Science Inc. All rights reserved.

- by Keisuke Ishii
- •
- Epilepsy, Treatment Outcome, Adolescent, Intellectual Disability
- by Ralph MANKTELOW
- •
- Wound Healing, Nuclear medicine, Radiotherapy, Cardiovascular disease

Patellar tendinitis is an overuse syndrome affecting the origin of the patellar tendon and its underlying part. Ultrasonography is useful to investigate tendinous pathology. It describes the anatomical lesions and their extent. Surgical excision of irreversible lesions, demonstrated on ultrasonography, is a logical attitude which provides good results.

- by Daniel Fritschy
- •
- Treatment Outcome, Prospective studies, Ultrasonography, Tendinopathy

Background. The operative management of absent pulmonary valve syndrome remains controversial regarding the need for pulmonary valve implantation and remodeling of pulmonary arteries. Moreover, symptomatic infants are considered to have a... more

- by Miguel Uva
- •
- Child, Infant, Follow-up studies, Clinical Sciences

Peripheral nerve stimulation and, recently, peripheral nerve field stimulation are excellent options for the control of extremity pain in instances where conventional methods have failed and surgical treatment is ruled inappropriate. New techniques, ultrasound guidance, smaller generators, and task-specific neuromodulatory hardware and leads result in increasingly safe, stable and efficacious treatment of pain in the extremities. Peripheral nerve stimulation has shown to be an increasingly viable option for many painful conditions with neuropathic and possibly nociceptive origins. This chapter focuses on the historical use of neuromodulation in the extremities, technical tasks associated with implant, selection of candidates, and potential pitfalls of and solutions for implanting devices around the peripheral nervous system for extremity pain.

- by Porter McRoberts
- •
- Ultrasound, Peripheral Nervous System, Peripheral Nerve, Extremities

Thirty nine surgical hallux valgus corrections in 32 adolescents (7 bilateral) performed between 1994 and 2001 were retrospectively studied. The mean age at the time of surgery was 14.2 years. The operation consisted of a proximal dome osteotomy of the first metatarsal, excision of the medial protuberance, lateral capsular and adductor release, and distal medial soft tissue plication. The patients were followed for an average of 42 months (range 32 to 62). Post-operative evaluation was based on the duPont bunion rating score. The result was excellent in 11 feet, good in 22 cases, fair in 5 and poor in 1 case. Using subjective criteria of the duPont score, such as cosmesis and discomfort, a satisfactory result was achieved in 35 feet (90%). Our opinion is that correction of the angle between the 1st and 2nd metatarsal as well as preservation of the length of the first metatarsal are of crucial importance in the surgical treatment of adolescent hallux valgus.

- by Christos Plakogiannis
- •
- Treatment Outcome, Adolescent, Retrospective Studies, Soft Tissue
- by Giulio Garaffa
- •
- Asian, Treatment Outcome, Erectile dysfunction, Doppler Ultrasound
- by Minerva Becker
- •
- Microsurgery, Treatment Outcome, Endoscopy, Length of Stay

Treatment of congenital pseudarthrosis of the tibia is still controversial, and vascularised fibula graft is a reliable method for consolidation, although complications can occur in the donor leg after fibula grafting. This study evaluates 16 patients with congenital pseudarthrosis of the tibia (CPT) treated with contralateral fibular graft, with regard to complications in the donor leg, and assesses the influence of distal tibiofibular joint arthrodesis in these complications. All patients with CPT were consecutively submitted to surgical treatment with contralateral fibular graft. The mean follow-up was 94 months, varying from 44 to 162 months. The long-term effects in the donor leg were determined, and 12 cases with distal tibiofibular arthrodesis (group 1) were compared with a group without arthrodesis (group 2). Half of the patients had proximal migration of the lateral malleolus. Eight patients had ankle valgus. Group 1 had an average valgus tilt angle of 5.8°, while group 2 had an average angle of 1.5°. There was no significant difference between the patients with or without distal tibiofibular joint arthrodesis. The patients with a distal fibula remnant smaller than 5 cm had greater valgus tilt angle measurements. Distal tibiofibular arthrodesis was not effective in preventing all the complications in the donor leg; however, it can lessen the severity of the complications. Our results show that a distal fibular remnant greater than 5 cm should be retained to prevent ankle valgus.

- by Ivan Chakkour
- •
- Adolescent, Orthopaedics, Child, Fibula

Intractable seizures are the most common manifestation in severe cases of tuberous sclerosis. Multidrug resistance type 1 (MDR1) gene expression is directly linked to the resistance of tumor cells to chemotherapy as the major cause of treatment failure, but it has not been reported in tuberous sclerosis cells nor has the relationship between the MDR1 gene and antiepileptic drugs been described. A 4-month-old female is described with poorly controlled seizures secondary to tuberous sclerosis. The patient was treated with antiepileptic drugs, including phenytoin, phenobarbital, and lorazepam, without improvement of symptoms. Phenytoin blood levels were invariably subtherapeutic and ranged from 0.45 to 3.55 g/mL, despite several consecutive intravenous loading doses. Surgical treatment with total resection of the brain lesions was performed as a last resort. Immunohistochemical analysis of the resected tissues revealed high levels of P-glycoprotein 170 expression, the product of the MDR1 gene. Both MDR1 gene expression and persistently low phenytoin levels likely share a common pathway liable to induce drug-resistant epilepsy.

- by Adrian Rabinowicz
- •
- Epilepsy, Immunohistochemistry, Treatment Outcome, Gene expression

Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9–10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.

- by Mehmet Turgut
- •
- Magnetic Resonance Imaging, Paraplegia, Back Pain, Staphylococcus aureus

After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major ro...

This paper presents the possibility of early detection and localization of epileptogenic focus in the iEEG (intracranial Electroencephalography) signal using a method based on multidimensional autoregressive models. The work provides the first results of the method in the iEEG signal, and discusses technical aspects in terms of the suitability of the sampling frequency, AR model order and segmentation step.

- by Petr Jezdik
- •
- Quality of life, Electroencephalography, Early Detection, DR-AR Model

Several studies of survival in women with BRCA1 mutations have shown either reduced survival or no difference compared to controls. Programmes for early detection and treatment of inherited breast cancer, have failed to demonstrate a... more

- by Steinar Tretli
- •
- Breast Cancer, Early Detection, Overall Survival, Adjuvant Chemotherapy

The ideal surgical treatment for complicated ventral hernias remains elusive. Traditional component separation provides local advancement of native tissue for tension-free closure without prosthetic materials. This technique requires an extensive subcutaneous dissection, with the division of perforating vessels predisposing to skin flap necrosis and complicated wound infections. The laparoscopic separation of components provides a minimally invasive alternative to open techniques, while eliminating the potential space and subsequent complications of large skin flaps. We report our initial experience with a minimally invasive component separation with early postoperative outcomes. We retrospectively reviewed the medical records of all patients who underwent a minimally invasive component separation for abdominal wall reconstruction during the resection of an infected prosthetic. Pertinent details included baseline demographics, reason for contamination, operative technique and detail...

- by Jeffrey Ponsky
- •
- Dissection, Respiratory Failure, Surgical Site Infection, Aged

RÉ SUMÉ But de l'étude : Le but de cette étude rétrospective était de rapporter les résultats du traitement chirurgical chez 188 patients opérés pour aspergillome pulmonaire dans une série de 206 patients observés au Maroc. Patients et méthode : De 1982De à 1998 patients ont été pris en charge dans le même centre pour aspergillome pulmonaire ; 188 patients ont été traités chirurgicalement, 18 patients ont été jugés inopérables à cause de l'altération de leur état général et/ou respiratoire. L'hémoptysie était le symptôme le plus souvent observé (dans 92 % des cas). L'exérèse chirurgicale a été réalisée par principe, avec 108 résections lobaires, 38 segmentaires, 18 lobaires et segmentaires, 21 pleuro-pneumonectomies et trois thoracoplasties. Résultats : Une complication postopératoire est survenue dans 36 % des cas. Les principales complications ont été : le pyothorax (15 cas), l'hémothorax (dix cas), le défaut de réhabitation (17 cas) et la détresse respiratoire (dix cas). Une réintervention a été nécessaire chez six patients. La mortalité postopératoire a été de 6,4 % (12 patients dont cinq traités par pleuro-pneumonectomie). Conclusion : Le traitement chirurgical de l'aspergillome pulmonaire malgré son importante morbidité, doit être proposé systématiquement même chez les sujets asymptomatiques, quand il n'y a pas de contre-indication opératoire. La pleuro-pneumonectomie est grave et doit être si possible évitée. La thoracoscopie a été rarement pratiquée dans cette série. © 1999 Éditions scientifiques et médicales Elsevier SAS aspergillome / hémoptysie / chirurgie pulmonaire ABSTRACT Pulmonary aspergilloma: results of surgical treatment. Report of 206 cases. Study aim: The aim of this retrospective study was to report the results of the surgical treatment in 188 patients operated on for pulmonary aspergilloma in a series of 206 patients observed in Morocco. Patients and method : From 1982 to 1998, 206 patients were treated for pulmonary aspergilloma in the same hospital ; 188 were operated on and surgery was contraindicated in the other patients with general or respiratory failure. Hemoptysis was the main symptom, present in 190 patients (92%). Surgery was performed on principle with 108 lobectomies, 38 segmentectomies, 18 lobectomies and segmentectomies, 21 pleuropneumonectomies and 3 thoracoplasties. Results : Postoperative complications occurred in 36% of the patients including: pyothorax (n=15), hemothorax (n=10), rehabitation defects (n=17) and respiratory failure (n=10). Reoperation was necessary in 6 patients. Postoperative mortality rate was 6,4% (12 patients including 5 treated by pleuro-pneumonectomy). Conclusion: The surgical treatment, in spite of its high morbidity, has to be proposed to all patients with pulmonary aspergilloma, even in asymptomatic patients when there is no surgical contraindication. Pleuropneumonectomy is a very high risk procedure and its indications must be restricted. Thoracoscopy was rarely performed in this series. © 1999 Éditions scientifiques et médicales Elsevier SAS aspergilloma / hemoptysis / pulmonary surgery L'aspergillome pulmonaire, qui est la cause la plus fréquente des hémoptysies, est responsable d'une importante mortalité dans une population jeune.

- by hassan achire
- •
- Case Study, Respiratory Failure, Postoperative Complication, Retrospective Study

Abdominal blunt trauma represents the main cause of death in people of age less than 40 years; the liver injury occurs frequently, with an incidence varying from 3 to 10%. Isolated hepatic lesions are rare and in 77-90% of cases, lesions of other organs and viscera are involved. Right hepatic lobe is a frequent site of injury, because it is the more voluminous portion of liver parenchyma; posterior superior hepatic segments are proximal to fixed anatomical structures such as ribs and spine that may have an important role in determining of the lesion. The coronal ligaments' insertion in this parenchymal region augments the effect of acceleration-deceleration mechanism. Associated lesions usually are homolateral costal fractures, laceration or contusion of the inferior right pulmonary lobe, haemothorax, pneumothorax, renal and/or adrenal lesions. Traumatic lesions of left hepatic lobe are rare and usually associated with direct impact on the superior abdomen, such as in car-crash ...

- by Luigia Romano
- •
- Computed Tomography, Emergency Medical Services, Liver, Diagnostic Imaging
- by Michiel Segers
- •
- Biomedical Engineering, Adolescent, Child, Horses