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Sample records for surgical management outcome

  1. Massive suprachoroidal hemorrhage: Surgical management and outcome

    PubMed Central

    Laube, Thomas; Brockmann, Claudia; Bornfeld, Norbert

    2015-01-01

    Objective: To describe options for vitreoretinal surgery in the management of massive suprachoroidal hemorrhage (SCH). Methods: Visual acuity (VA), ocular findings, timing of surgical intervention, surgical procedures, and outcomes of four patients diagnosed with massive SCH and admitted to the University Eye Clinic Essen were reviewed retrospectively. Results: Four eyes of four patients (mean age, 82 years; range, 74–89 years) were studied. In three cases the occurrence of SCH was related to cataract surgery and occurred intra- or postoperatively. One patient developed spontaneous SCH of unclear origin. Three patients had a history of arterial hypertension; one eye had high myopia, two patients suffered from cardiovascular diseases, and two patients had glaucoma. Postoperative follow up of the patients ranged from 5 to 29.5 months (mean, 19.6 months). Transscleral drainage of SCH was in all cases combined with pars plana vitrectomy, use of heavy liquids (perfluorodecalin) and silicone oil tamponade. The mean time interval from hemorrhage to surgical intervention was 16.5 days (range 5–29 days). Preoperative VA of all eyes was light perception. Two patients achieved a final postoperative visual acuity of 20/20 and 20/320, respectively, one patient improved to hand motion, and one patient resulted in no light perception. Conclusions: Surgical interventions including transscleral drainage of SCH, vitrectomy, and silicone oil tamponade are valuable options in the management of massive SCH to save the eye and possibly improve the otherwise extreme poor prognosis.

  2. Spinal meningiomas: surgical management and outcome.

    PubMed

    Gottfried, Oren N; Gluf, Wayne; Quinones-Hinojosa, Alfredo; Kan, Peter; Schmidt, Meic H

    2003-06-15

    Advances in imaging and surgical technique have improved the treatment of spinal meningiomas; these include magnetic resonance imaging, intraoperative ultrasonography, neuromonitoring, the operative microscope, and ultrasonic cavitation aspirators. This study is a retrospective review of all patients treated at a single institution and with a pathologically confirmed diagnosis of spinal meningioma. Additionally the authors analyze data obtained in 556 patients reported in six large series in the literature, evaluating surgical techniques, results, and functional outcomes. Overall, surgical treatment of spinal meningiomas is associated with favorable outcomes. Spinal meningiomas can be completely resected, are associated with postoperative functional improvement, and the rate of recurrence is low. PMID:15669787

  3. Clinical outcomes in surgical and non-surgical management of hepatic portal venous gas

    PubMed Central

    Yoo, Soo-Kyung; Park, Jong-Hoon

    2015-01-01

    Backgrounds/Aims Hepatic portal venous gas (HPVG) is a rare condition, with poor prognosis and a mortality rate of up to 75%. Indications for surgical and non-surgical management of HPVG including associated complications and mortality remain to be clarified. Methods From January 2008 to December 2014, 18 patients with HPVG diagnosed through abdominal computed tomography (CT) imaging were retrospectively identified. Clinical symptoms, laboratory data, underlying diseases, treatment, and mortality rate were analyzed. Patients were classified into 2 groups: surgical management recommended (SR, n=10) and conservative management (CM, n=8). The SR group was further subdivided into patients who underwent surgical management (SM-SR, n=5) and those who were managed conservatively (NS-SR, n=5). Results Conditions underlying HPVG included mesenteric ischemia (38.9%), intestinal obstruction (22.2%), enteritis (22.2%), duodenal ulcer perforation (5.6%), necrotizing pancreatitis (5.6%), and diverticulitis (5.6%). In terms of mortality, 2 patients (40%) died in the SM-SR group, 1 (12.5%) in the CM group, and 100% in the NS-SR group. Higher scores from Acute Physiology and Chronic Health Evaluation (APACHE) II predicted the mortality rates of the NS-SR and CM groups. Conclusions Identification of HPVG requires careful consideration for surgical management. If surgical management is indicated, prompt laparotomy should be performed. However, even in the non-surgical management condition, aggressive laparotomy can improve survival rates for patients with high APACHE II scores. PMID:26693238

  4. Current management and surgical outcomes of medically intractable epilepsy.

    PubMed

    Ramey, Wyatt L; Martirosyan, Nikolay L; Lieu, Corinne M; Hasham, Hasnain A; Lemole, G Michael; Weinand, Martin E

    2013-12-01

    ) have lead to progressively better long-term seizure outcomes by increasing the neurosurgeon's visualization of supposed non-lesional foci. Additionally, being historically viewed as a drastic surgical intervention for MIE, hemispherectomy has been extensively used quite successfully for diffuse epilepsies often found in pediatric patients. Although total anatomic hemispherectomy is not utilized as commonly today, it has given rise to current disconnective techniques such as hemispherotomy. Therefore, severe forms of hemispheric developmental epilepsy can now be surgically treated while substantially decreasing the amount of potential long-term complications resulting from cavitation of the brain following anatomical hemispherectomy. Despite the rapid pace at which we are gaining further knowledge about epilepsy and its surgical treatment, there remains a sizeable underutilization of such procedures. By reviewing the recent literature on resective treatment of MIE, we provide a recent up-date on epilepsy surgery while focusing on historical perspectives, techniques, prognostic indicators, outcomes, and complications associated with several different types of procedures. PMID:24169149

  5. Patient outcomes following surgical management of multinodular goiter

    PubMed Central

    Lin, Yann-Sheng; Wu, Hsin-Yi; Yu, Ming-Chin; Hsu, Chih-Chieh; Chao, Tzu-Chieh

    2016-01-01

    Abstract Background: the difference in the risk of thyroid malignancy for patients with multinodular goiter (MNG) and solitary nodular goiter (SNG) remains controversial. Although total thyroidectomy (TT) is the current preferred surgical option for MNG, permanent hypothyroidism in these patients may be a concern. Therefore, we discuss whether nontotal thyroidectomy is a reasonable alternative surgical option. Methods: A retrospective cohort study was performed for 1598 consecutive patients who underwent thyroid surgery for nodular goiter between January 2007 and December 2012. Numerous clinical parameters were collected and analyzed. Results: We reviewed 795 patients with MNG and 803 patients with SNG. The prevalence of malignancy on final pathology was significantly higher in the patients with MNG than in the patients with SNG (15.6% vs 10.1%, P = 0.001). However, a multivariate analysis revealed that this difference was insignificant (P = 0.50). Papillary carcinoma was the predominant type in both groups, but papillary microcarcinoma was more frequently found (41.1%) in the patients with MNG. The only multifocal cancers were of the papillary carcinoma histologic type, and the incidence of multifocal papillary carcinoma was significantly higher in the patients with MNG (23.4% vs 7.4%, P = 0.005). Reoperation was not required for the patients who underwent TT for goiter recurrence or incidental carcinoma. The overall rate of recurrence following nontotal thyroidectomy was 12.2%. Among the patients who underwent reoperation for goiter recurrence, 2 (20.0%) were complicated with permanent hypoparathyroidism. Among the patients who underwent a nontotal bilateral thyroidectomy, an average of 56.5% had permanent hypothyroidism. Conclusions: Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop papillary carcinoma are at an increased risk of cancer multifocality. If a patient can tolerate lifelong thyroid hormone

  6. Congenital facial teratoma in a neonate: Surgical management and outcome.

    PubMed

    Kekre, Geeta; Gupta, Abhaya; Kothari, Paras; Dikshit, Vishesh; Patil, Prashant; Deshmukh, Shahji; Kulkarni, Apoorva; Deshpande, Aditi

    2016-01-01

    Teratomas are among the most common tumors of childhood, but craniofacial teratomas are rare. They can be diagnosed antenatally. Craniofacial teratomas may cause airway obstruction in the newborn. We present a case of a newborn male child who was diagnosed to have a facial tumor in the 8(th) month of gestation. He was delivered normally and had no respiratory or feeding difficulties. He was also found to have a cleft palate. Serum alpha fetoprotein levels were normal. He underwent excision on day of life 9. At 11 months follow-up, he is well with no evidence of recurrence and good functional outcome. PMID:27563624

  7. Congenital facial teratoma in a neonate: Surgical management and outcome

    PubMed Central

    Kekre, Geeta; Gupta, Abhaya; Kothari, Paras; Dikshit, Vishesh; Patil, Prashant; Deshmukh, Shahji; Kulkarni, Apoorva; Deshpande, Aditi

    2016-01-01

    Teratomas are among the most common tumors of childhood, but craniofacial teratomas are rare. They can be diagnosed antenatally. Craniofacial teratomas may cause airway obstruction in the newborn. We present a case of a newborn male child who was diagnosed to have a facial tumor in the 8th month of gestation. He was delivered normally and had no respiratory or feeding difficulties. He was also found to have a cleft palate. Serum alpha fetoprotein levels were normal. He underwent excision on day of life 9. At 11 months follow-up, he is well with no evidence of recurrence and good functional outcome.

  8. Modern surgical techniques for management of soft tissue sarcomas involving the spine: outcomes and complications.

    PubMed

    Mattei, Tobias A; Teles, Alisson R; Mendel, Ehud

    2015-04-01

    Several types of soft tissue sarcomas may locally extend to the spine. The best therapeutic strategy for such lesions strongly depends on the histological diagnosis. In this article the authors provide an up-to-date review of current guidelines regarding the management of soft tissue sarcomas involving the spine. Special attention is given to outcomes and complications of modern surgical series in order to highlight current challenges in the management of such lesions. PMID:25413665

  9. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

    PubMed Central

    Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

    2016-01-01

    Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

  10. Congenital funnel anus in children: associated anomalies, surgical management and outcome.

    PubMed

    Suomalainen, Anna; Wester, Tomas; Koivusalo, Antti; Rintala, Risto J; Pakarinen, Mikko P

    2007-12-01

    Funnel anus (FA) is a rare and distinct type of anorectal malformation characterized by a skin-lined deep anal funnel, missing transitional epithelium and stenosis secondary to fibrotic internal sphincter. We aimed to characterize associated anomalies, surgical management and outcome of children with FA. The hospital records of 11 consecutive children (7 boys) treated for FA between 1992 and 2006 were screened. The collected data included the type of anorectal malformation, surgical management, associated anomalies, results of diagnostic investigations and outcome. Only one patient was free of any associated malformation. Six patients had a complete Currarino syndrome. Seven patients had a hemisacrum (scimitar) and tethered cord was present in two cases. Six patients underwent excision of a benign presacral teratoma. Anal stenosis associated with FA was managed by serial dilatations. Subsequent resection of the megarectosigmoid secondary to refractory constipation was performed on five occasions. Three patients underwent coloanal pull-through for Hirschsprung's disease (HD). The level of aganglionosis was at the rectosigmoid junction in two cases and low in the rectum in one. One additional patient had hypoganglionosis. Of the three patients with HD two also had Down's syndrome. After median follow-up of 6.5 (0.3-13.5) years four patients have normal bowel function and four suffer from soiling. Two patients with HD and Down's syndrome and one patient with an undefined syndrome are fecally incontinent. Associated anomalies are common and diverse in children with FA. Pelvic MRI, sacral radiography, evaluation of the urinary tract and rectal biopsies are recommended as routine investigations in cases of FA. Surgical care of these patients is demanding and should be confined to dedicated centers. PMID:17929036

  11. Surgical management and outcomes of type A dissection—the Mayo Clinic experience

    PubMed Central

    Cabasa, Alduz

    2016-01-01

    Background Type A aortic dissection (TAAD) is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. The most effective approach is still being debated—such as the best cannulation technique, and conservative versus extensive initial surgery. We reviewed our experience over the last 20 years and examined for variables that correlated with observed outcomes. Methods All patients who underwent TAAD repair were reviewed. Chi-Square tests, Fisher Exact tests and Wilcoxon tests were performed where appropriate. Survival and freedom from reoperations were analyzed with the Kaplan-Meier actuarial method. Results Acute TAAD was associated with a higher incidence of permanent stroke (P=0.010), renal failure (P=0.025), prolonged mechanical ventilator support (P=0.004), higher operative mortality (P=0.039) and higher 30-day mortality (P=0.003) compared to chronic TAAD. There was a trend towards higher risk for transient neurologic events among patients who were reoperated on (P=0.057). Extensive proximal repair led to longer perfusion and cross clamp times (P<0.001) and the need for temporary mechanical support post-operatively (P=0.011). More patients that had extensive distal repair underwent circulatory arrest (P=0.009) with no significant differences in the incidence of peri-operative complications, early, middle and long-term survival compared to the conservative management group. Overall survival in our series was 66.73% and 46.30% at 5 and 10 years respectively (median survival time: 9.38 years). There was a significant improvement in operative mortality (P=0.002) and 30-day mortality (P=0.033) in the second decade of our study. Discussion TAAD is a complex disease with several options for its surgical management. Each technique has its own advantages and complications and surgical management should be individualized depending on the clinical presentation. We propose our present approach to maximize benefits in both the

  12. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    PubMed Central

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Jain, Vijendra K.; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospective study. Materials and Methods: One hundred and fifteen patients (male:female ratio: 1:1.09) with acromegalic features were studied. Apart from acromegalic features, their main clinical presentation also included headache, diminution of vision, field defects, ptosis, irregular menstruation, diabetes insipidus, diabetes mellitus and hypertension. Six of them presented with apoplexy. Their preoperative endocrinal evaluation included basal and suppressed growth hormone (GH), prolactin and thyroid levels. On the basis of axial and coronal CT scan or multiplanar MR imaging or both, the tumors were classified according to their suprasellar and parasellar extension (Hardy's grade). Transnasal trans-sphenoidal surgery (TSS) (n = 37) and sublabial, rhinoseptal TSS (n = 72) were the preferred approaches. Six patients with significant parasellar extensions underwent trans-cranial explorations. The patients were followed up at 6 and 12 weeks and then at 6 monthly intervals. Hormonal and CT/MR evaluation were also done. Attainment of random GH value less than 2.5 µg/L, and the nadir GH value after oral glucose tolerance test (OGTT) less than 1 µg/L were used as the criteria of cure. Findings: The patients were preoperatively in Hardy's tumor grade 0 (29), A (21), A+E (3), B (21), B+E (5), C (9), C+E (10), D (1) D+E (11), E (5), respectively. One hundred and one patients were available for follow-up (FU; median FU duration: 84 months; range: 6 to 132 months). Surgical cure was achieved

  13. Late outcomes for the surgical management of absent pulmonary valve syndrome in infants

    PubMed Central

    Hu, Renjie; Zhang, Haibo; Xu, Zhiwei; Liu, Jinfen; Su, Zhaokang; Ding, Wenxiang

    2013-01-01

    OBJECTIVES Absent pulmonary valve syndrome (APVS) is a rare cardiac malformation that is usually associated with aneurysmal dilatation of pulmonary arteries and respiratory distress. The surgical mortality of neonates and infants with APVS has decreased tremendously, from 60% in 1980s to 10–20% recently. This study retrospectively reviews surgical outcomes of our 10-year experience in patients with APVS. METHODS From 2002 to 2012, 42 patients with APVS underwent surgical correction. Thirty-seven patients had APVS as a variant of tetralogy of Fallot, 4 with double outlet right ventricle and 1 with ventricular septal defect. Respiratory distress was present in 12 infants. Four patients needed continuous positive airway pressure and 5 required intubation with mechanical ventilation before surgery. RESULTS There was no hospital death and 3 late deaths. The mean follow-up time was 62.71 ± 34.31 months. Significant differences were found in the duration of postoperative ventilation between patients with or without respiratory distress (P = 0.009) and patients with left or right aortic arch (P = 0.012). The Kaplan–Meier curve indicated that overall survival at 5 and 10 years was 92.4%. The survival rates between patients with or without respiratory distress were 72.7 and 100%, respectively (P = 0.003). Overall mortality was associated with longer cardiopulmonary bypass time (P = 0.004) and lower weight at operation (P = 0.042). There were no significant differences in survival and postoperative data such as the duration of ventilation or intensive care unit stay and New York Heart Association class among the three methods of right ventricular outflow tract (RVOT) reconstruction. CONCLUSIONS Surgical treatment of APVS has got favourable outcomes in terms of mortality and reoperation rate. Different methods of RVOT reconstruction do not affect the surgical outcome. Patients required long-term follow-up for postoperative respiratory complications secondary to persistent

  14. Hepatocellular Carcinoma: Current Management and Future Development—Improved Outcomes with Surgical Resection

    PubMed Central

    Kishi, Yoji; Hasegawa, Kiyoshi; Sugawara, Yasuhiko; Kokudo, Norihiro

    2011-01-01

    Currently, surgical resection is the treatment strategy offering the best long-term outcomes in patients with hepatocellular carcinoma (HCC). Especially for advanced HCC, surgical resection is the only strategy that is potentially curative, and the indications for surgical resection have expanded concomitantly with the technical advances in hepatectomy. A major problem is the high recurrence rate even after curative resection, especially in the remnant liver. Although repeat hepatectomy may prolong survival, the suitability may be limited due to multiple tumor recurrence or background liver cirrhosis. Multimodality approaches combining other local ablation or systemic therapy may help improve the prognosis. On the other hand, minimally invasive, or laparoscopic, hepatectomy has become popular over the last decade. Although the short-term safety and feasibility has been established, the long-term outcomes have not yet been adequately evaluated. Liver transplantation for HCC is also a possible option. Given the current situation of donor shortage, however, other local treatments should be considered as the first choice as long as liver function is maintained. Non-transplant treatment as a bridge to transplantation also helps in decreasing the risk of tumor progression or death during the waiting period. The optimal timing for transplantation after HCC recurrence remains to be investigated. PMID:21994868

  15. Surgical management of symptomatic brain stem cavernoma in a developing country: technical difficulties and outcome.

    PubMed

    Farhoud, Ahmed; Aboul-Enein, Hisham

    2016-07-01

    Brain stem cavernomas (BSCs) are angiographically occult vascular malformations in an intricate location. Surgical excision of symptomatic BSCs represents a neurosurgical challenge especially in developing countries. We reviewed the clinical data and surgical outcome of 24 consecutive cases surgically treated for brain stem cavernoma at the Neurosurgery Department, Alexandria University, between 2006 and 2014. All patients were followed up for at least 12 months after surgery and the mean follow-up period was 45 months. All patients suffered from at least two clinically significant hemorrhagic episodes before surgery. There were 10 males and 14 females. The mean age was 34 years (range 12 to 58 years). Fourteen cases had pontine cavernomas, 7 cases had midbrain cavernomas, and in 3 cases, the lesion was found in the medulla oblongata. The most commonly used approach in this series was the midline suboccipital approach with or without telovelar exposure (9 cases). There was a single postoperative mortality in this series due to pneumonia. Fourteen cases (58.3 %) showed initial worsening of their preoperative neurological status, most of which was transient and only three patients had permanent new deficits and one case had a permanent worsening of her preoperatively existing hemiparesis. There was neither immediate nor long-term rebleeding in any of our cases. In spite of the significant associated risks, surgery for BSCs in properly selected patients can have favorable outcomes in most cases. Surgery markedly improves the risk of rebleeding and should be considered in patients with accessible lesions. PMID:27053221

  16. Electronic surgical record management.

    PubMed

    Rockman, Justin

    2010-01-01

    This paper explores the challenges surgical practices face in coordinating surgeries and how the electronic surgical record management (ESRM) approach to surgical coordination can solve these problems and improve efficiency. Surgical practices continue to experience costly inefficiencies when managing surgical coordination. Application software like practice management and electronic health record systems have enabled practices to "go digital" for their administrative, financial, and clinical data. However, surgical coordination is still a manual and labor-intensive process. Surgical practices need to create a central and secure record of their surgeries. When surgical data are inputted once only and stored in a central repository, the data are transformed into active information that can be outputted to any form, letter, calendar, or report. ESRM is a new approach to surgical coordination. It enables surgical practices to automate and streamline their processes, reduce costs, and ensure that patients receive the best possible care. PMID:20480775

  17. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach

    PubMed Central

    Rovlias, Aristedis; Theodoropoulos, Spyridon; Papoutsakis, Dimitrios

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications. This study evaluated the clinical features, radiological findings, and neurological outcome in a large series of patients with CSDH. Methods: A classification and regression tree (CART) technique was employed in the analysis of data from 986 patients who were operated at Asclepeion General Hospital of Athens from January 1986 to December 2011. Burr holes evacuation with closed system drainage has been the operative technique of first choice at our institution for 29 consecutive years. A total of 27 prognostic factors were examined to predict the outcome at 3-month postoperatively. Results: Our results indicated that neurological status on admission was the best predictor of outcome. With regard to the other data, age, brain atrophy, thickness and density of hematoma, subdural accumulation of air, and antiplatelet and anticoagulant therapy were found to correlate significantly with prognosis. The overall cross-validated predictive accuracy of CART model was 85.34%, with a cross-validated relative error of 0.326. Conclusions: Methodologically, CART technique is quite different from the more commonly used methods, with the primary benefit of illustrating the important prognostic variables as related to outcome. Since, the ideal therapy for the treatment of CSDH is still under debate, this technique may prove useful in developing new therapeutic strategies and approaches for patients with CSDH. PMID:26257985

  18. The functional outcome of blow-out fractures managed surgically and conservatively: our experience in 100 patients.

    PubMed

    Felding, Ulrik Ascanius; Rasmussen, Janne; Toft, Peter Bjerre; von Buchwald, Christian

    2016-07-01

    The proportion of orbital blow-out fractures (BOFs) which are operated upon varies. The purpose of this study was to determine the treatment pattern of BOFs at our tertiary trauma centre and to evaluate the functional outcomes in patients according to whether they were managed surgically or conservatively. The study design is a retrospective cohort study and the setting is Tertiary care University Hospital. The participants include patients with isolated BOFs admitted to our Trauma Unit from 2010 to 2013. Of the 100 consecutive patients included, 60 had available follow-up data. The presence of diplopia and enophthalmus was determined by reviewing the medical records. Data from the patients' initial consultation and their 3-month follow-up were also collected. Of the 60 patients whose data could be analysed, 36 had been managed surgically and 24 conservatively. Of the patients managed surgically, 25 had diplopia in peripheral gaze before surgery and 12 at 3-month follow-up. Nine had diplopia in primary gaze before surgery and none at 3-month follow-up. Five had enophthalmus before surgery and two at 3-month follow-up. Of the patients managed conservatively, eight had diplopia in peripheral gaze initially and seven at 3-month follow-up. Three had diplopia in primary gaze initially and one at 3-month follow-up. One had enophthalmus initially which was still present at 3-month follow-up. Primary gaze diplopia disappeared while secondary gaze diplopia was present in about a third of patients, whether managed surgically or conservatively at the 3-month follow-up. Standardised follow-up as well as clear indications for and against surgery are warranted. PMID:26935055

  19. Outcomes of surgical treatment of Peyronie's disease.

    PubMed

    Carson, Culley C; Levine, Laurence A

    2014-05-01

    The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer-reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non-systematic review included 'Peyronie's disease', 'outcomes', 'complications', 'erectile dysfunction or ED', 'patient expectation', and 'patient satisfaction'; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty-one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non-surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug-resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures

  20. Clinical assessment is sufficient to allow outcome evaluation following surgical management of Achilles tendon ruptures

    PubMed Central

    Todorov, Atanas; Schaub, Frederic; Blanke, Fabian; Heisterbach, Patricia; Sachser, Franciska; Gösele, Andreas; Majewski, Martin

    2015-01-01

    Summary Study design cross-sectional study in otherwise healthy athletic adults with a unilateral Achilles tendon rupture. Objectives define the relationships of active range of motion, calf circumference or number of heel raises to a full set of isokinetic parameters. Background Achilles tendon ruptures commonly occur during sports and create a considerable amount of morbidity. The benefits of different treatments are difficult to determine. Complex and expensive isokinetic testing is often required. If a simple force measurement could replace this testing, large clinical trials would be more easily feasible. Methods 74 patients with acute Achilles tendon rupture and surgical treatment were evaluated retrospectively. Active range of motion (ROM), ratio of ROM, number of heel raises, ratio of heel raises, calf circumference and isokintetic measurements were recorded. Regression using a Bayesian elastic net showed the most important correlations. Results Active range of motion showed a significant correlation to peak torque angle at flexion and extension as well as increased sports activity. There was a negative correlation to percutaneous therapy. Active Heel raise showed a positive correlation to peak torque at dorsal extension and increased sports activity as well as a negative correlation to high postoperative pain, where as calf circumference was positive correlated to peak torque at dorsal extension and body height as well as negative correlated to female gender. Conclusion device independent measures, like range of Motion, and amount of Heel raise, are an excellent tool providing similar information compared to isokinetic testing and could be used to evaluate clinical outcome after Achilles tendon rupture. PMID:26261784

  1. Late radiation injury of the colon and rectum. Surgical management and outcome

    SciTech Connect

    Kimose, H.H.; Fischer, L.; Spjeldnaes, N.; Wara, P. )

    1989-08-01

    After a median latency of 2 years, the initial late colorectal radiation injuries in 182 patients were: stricture (37 percent), minor lesions (36 percent), rectovaginal fistula (22 percent), and gangrene or other fistulas (5 percent). Due to progression, new colorectal injuries, primarily stricture (55 percent) and fistula (42 percent), occurred in 68 patients (37 percent). Resection provided the best results. However, the resectability rate was low (46 percent) and resection was primarily performed in patients with a circumscript well-defined stricture of the proximal rectum or sigmoid colon with an anastomotic leakage rate of 5 percent. The prevailing management of 78 patients with fistula or stricture with synchronous fistula was defunctioning colostomy, primarily end-sigmoidostomy, providing fair results in half of the patients. Stomal complications occurred in 15 percent. The radiation-induced colorectal mortality was 8 percent. Colorectal fistula and associated radiation injuries of the urinary tract, and especially of the small bowel, were the major determinants of fatal outcome, yielding an overall radiation-induced mortality of 25 percent. After a median observation time of 13 years, half of the patients were alive at follow-up; 56 percent of these had a fair outcome whereas the remaining patients continued to have mild symptoms responding to conservative measures (34 percent) or disabling symptoms (10 percent).

  2. Does Surgical Management of the Hand in Children with Spastic Unilateral Cerebral Palsy Affect Functional Outcome?

    ERIC Educational Resources Information Center

    van Munster, Judith C.; Maathuis, Karel G. B.; Haga, Nienke; Verheij, Nienke P.; Nicolai, Jean-Philippe A.; Hadders-Algra, Mijna

    2007-01-01

    The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functional outcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of…

  3. Surgical Outcome of Spinal Neurilemmoma

    PubMed Central

    Yeh, Kuang-Ting; Lee, Ru-Ping; Yu, Tzai-Chiu; Chen, Ing-Ho; Peng, Cheng-Huan; Liu, Kuan-Lin; Wang, Jen-Hung; Wu, Wen-Tien

    2015-01-01

    Abstract Neurilemmoma commonly occurs from the fourth to sixth decades of life with an incidence of 3 to 10 per 100,000 people, and is rare in adolescence. This case report describes the clinical and radiographic features of 2 rare cases with intraspinal neurilemmoma of the cervical and thoracic spine. A 29-year-old man who experienced middle back pain with prominent right lower limb weakness, and an 11-year-old boy who suffered from sudden onset neck pain with left arm weakness and hand clawing for 2 weeks before admission to our department were included in this case report. Magnetic resonance imaging of both patients revealed an intraspinal mass causing spinal cord compression at the cervical and thoracic spine. The patients subsequently received urgent posterior spinal cord decompression and tumor resection surgery. The histopathology reports revealed neurilemmoma. The 2 patients recovered and resumed their normal lives within 1 year. Intraspinal neurilemmoma is rare but should be considered in the differential diagnosis of spinal cord compression. Advances in imaging techniques and surgical procedures have yielded substantially enhanced clinical outcomes in intraspinal neoplasm cases. Delicate preoperative study and surgical skill with rehabilitation and postoperative observation are critical. PMID:25654395

  4. Surgical management of velopharyngeal dysfunction: outcome analysis of autogenous posterior pharyngeal wall augmentation.

    PubMed

    Witt, P D; O'Daniel, T G; Marsh, J L; Grames, L M; Muntz, H R; Pilgram, T K

    1997-04-01

    Posterior pharyngeal wall augmentation has been advocated for patients having velopharyngeal dysfunction with a small coronal gap. Nonautogenous augmentation has not been accepted widely because of migration or extrusion of alloplastic implants and resorption of injected materials. Autogenous posterior pharyngeal wall augmentation has been performed for decades by Italian surgeons. A retrospective study was conducted to evaluate the efficacy of this procedure. Autogenous posterior pharyngeal wall augmentation, using a rolled superiorly based pharyngeal myomucosal flap, was performed on 14 patients, between November of 1989 and June of 1992, who fulfilled two criteria: velopharyngeal dysfunction unresponsive to speech therapy and a small (< 20 percent) coronal gap on velopharyngeal nasendoscopy. Of these, 3 patients had prior prosthetic velopharyngeal management, including 2 patients with Robin sequence. All patients were evaluated preoperatively and 3 months postoperatively with recorded (audio-videotape) perceptual, nasendoscopic, and fluoroscopic standardized speech and airway evaluations. The tapes were used for construction of a randomized master tape that was presented in blinded fashion and random order to three skilled raters for independent assessment of numerous perceptual and instrumental parameters of speech. The raters were uninvolved in the care of the patients or this study, and their intraobserver and interobserver reliabilities were known. Preoperatively, the majority of patients had nasal turbulence. All patients had variable degrees of hypernasality ranging from intermittent to pervasive. Parameters rated included (1) resonance (hypernasality, hyponasality, mixed), (2) auditory nasal emission (including nasal turbulence), and (3) visual characteristics regarding velopharyngeal closure. The visual parameters consisted of questions about whether a pharyngeal bulge was present or absent, descriptions of posterior pharyngeal wall movements with speech

  5. Surgical outcome in cystic vestibular schwannomas

    PubMed Central

    Nair, Suresh; Baldawa, Sachin S.; Gopalakrishnan, Chittur Viswanathan; Menon, Girish; Vikas, Vazhayil; Sudhir, Jayanand B.

    2016-01-01

    Background: Cystic vestibular schwannomas (VS) form a rare subgroup that differs from the solid variant clinically, radiologically, and histopathologically. These tumors also vary in their surgical outcome and carry a different risk of post-operative complications. We analyzed our series of 64 patients with cystic VS and discuss the technical difficulties related to total excision of these tumors and focus on complication avoidance. Materials and Methods: A retrospective review of cystic VS surgically managed over a span of 11 years. The case records were evaluated to record the clinical symptoms and signs, imaging findings, surgical procedure, complications, and follow-up data. Post-operative facial nerve palsy was analyzed with respect to tumor size and tumor type. Results: Progressive hearing impairment was the most common initial symptom (76.6%). Atypical initial symptoms were present in 15 patients (23.4%). Preoperatively, 78% patients had good facial nerve function (HB grade 1, 2) and 22% had intermediate (HB grade 3, 4) to poor (HB grade 5 and 6) function. Mean tumor size was 4.1 cm. Complete tumor removal was achieved in 53 patients (83%). The facial nerve was anatomically intact but thinned out after tumor excision in 38 patients (59.4%). Ninety percent patients had either intermediate or poor facial nerve function at follow-up. Poor facial nerve outcome was associated with giant tumors and peripherally located, thin-walled cystic tumors. Conclusion: Resection of cystic VS is complicated by peritumoral adhesions of the capsule to the nerve. Extensive manipulation of the nerve in order to dissect the tumor–nerve barrier results in worse facial nerve outcome. The outcome is worse in peripherally located, thin-walled cystic VS as compared to centrally located, thick-walled cystic tumors. Subtotal excision may be justified, especially in tumors with dense adhesion of the cyst wall to the facial nerve in order to preserve nerve integrity. PMID:27366248

  6. Recalcitrant Hidradenitis Suppurativa: An Investigation of Demographics, Surgical Management, Bacterial Isolates, Pharmacologic Intervention, and Patient-reported Health Outcomes.

    PubMed

    Thomas, Cristina; Rodby, Katherine A; Thomas, Jessina; Shay, Elizabeth; Antony, Anuja K

    2016-04-01

    Hidradenitis suppurativa (HS) is characterized by chronic inflammation, recurrent abscesses, and scarring. Surgery is performed when medical management and antibiotic therapy fails. This study sought to evaluate the demographics, surgical procedures, bacteriology, pharmacologic intervention, and quality of life of patients with recalcitrant HS requiring surgical intervention. A retrospective chart review was performed of 76 recalcitrant HS patients at the University of Illinois Medical Center. Patient demographics, bacterial culture, and surgery data were reviewed. Quality of life was assessed using the 36-item short-form health survey. Patients were mostly female (73.7%) and African American (81.6%) with a mean duration of symptoms of 8.6 years before surgery. Patients underwent at least one surgical procedure, most often to the axillae (57.6%) and 73.7 per cent received antibiotics. The most common culture isolates were Corynebacterium species (14.0%), Staphylococcus epidermidis (13.1%), and Staphylococcus aureus (10.4%) with varying resistance patterns. Surveyed patients had depressed 36-item short-form health survey physical functioning and social functioning scores. Recalcitrant HS patients with progressive symptomology over approximately nine years before surgical intervention were more likely to be African American women with axillary HS. Quality of life was diminished. We recommend initial treatment of HS with clindamycin and trimethoprim-sulfamethoxazole in clindamycin refractory cases. PMID:27097631

  7. Surgical Brain Metastases: Management and Outcome Related to Prognostic Indexes: A Critical Review of a Ten-Year Series

    PubMed Central

    Caroli, Manuela; Di Cristofori, Andrea; Lucarella, Francesca; Raneri, Fabio Angelo; Portaluri, Francesco; Gaini, Sergio Maria

    2011-01-01

    Brain metastasis are the most common neoplastic lesions of the nervous system. Many cancer patients are diagnosed on the basis of a first clinical presentation of cancer on the basis of a single or multiple brain lesions. Brain metastases are manifestations of primary disease progression and often determine a poor prognosis. Not all patients with a brain metastases undergo surgery: many are submitted to alternative or palliative treatments. Management of patients with brain metastases is still controversial, and many studies have been developed to determine which is the best therapy. Furthermore, management of patients operated for a brain metastasis is often difficult. Chemotherapy, stereotactic radiosurgery, panencephalic radiation therapy, and surgery, in combination or alone, are the means most commonly used. We report our experience in the management of a ten-year series of surgical brain metastasis and discuss our results in the preoperative and postoperative management of this complex condition. PMID:22084749

  8. Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study

    PubMed Central

    Göransson, Harry; Leppänen, Olli V; Vastamäki, Martti

    2016-01-01

    Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women) having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43%) in neurolysis, 59° (71%) in direct nerve repair, and 30° (22%) in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected. PMID:27152195

  9. Surgical management of breast cancer liver metastases

    PubMed Central

    Cassera, Maria A; Hammill, Chet W; Ujiki, Michael B; Wolf, Ronald F; Swanström, Lee L; Hansen, Paul D

    2011-01-01

    Introduction Selected patients with isolated breast cancer liver metastases (BCLM) may benefit from surgical management; however, indications remain unclear and the risks may outweigh the benefits in patients with a generally poor prognosis. Methods Between 1998 and 2006, 17 patients diagnosed with BCLM were considered for surgical management (<4 tumours, tumour <4 cm in diameter and no/stable extrahepatic metastases). Peri-operative and outcomes data were analysed and compared. Results Eight patients were found to have extensive or untreatable disease on staging laparoscopy and intra-operative ultrasound (SL/IOUS). The remaining nine patients underwent surgical management [seven laparoscopic radiofrequency ablations (RFA) and two hepatic resections]. Median length of follow-up for patients treated surgically was 40.0 months, median disease-free survival (DFS) was 32.2 months and median time to disease progression was 17.7 months. Of the eight patients not amenable to surgery, median length of follow-up was 21.8 months. Conclusion SL/IOUS prevented unnecessary laparotomy in half of the patients taken to the operating room for surgical treatment of BCLM. In patients with BCLM, SL/IOUS should be considered standard of care before surgical intervention. The small number of patients and short follow-up may be inadequate to determine the true value of surgical management in this group of patients with BCLM. PMID:21418133

  10. Investing in a Surgical Outcomes Auditing System

    PubMed Central

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben

    2013-01-01

    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763

  11. Investing in a surgical outcomes auditing system.

    PubMed

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben

    2013-01-01

    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763

  12. Surgical technique affects outcomes in acromioclavicular reconstruction.

    PubMed

    Grassbaugh, Jason A; Cole, Chad; Wohlrab, Kurt; Eichinger, Josef

    2013-01-01

    Optimal treatment for acromioclavicular (AC) dislocation is unknown. Numerous surgical procedures for AC injuries have been described with little comparison. This study sought to compare the clinical and radiographic results of various surgical techniques in order to identify the optimal surgical technique. Ninety patients met inclusion criteria of AC reconstruction at this institution. A retrospective review of outcomes was performed using the electronic records system. Radiographs were measured for pre- and postoperative grade and percent elevation versus the contralateral side. Overall revision rate was 9%. Suture button fixation had a revision rate of 0% compared to 14% (p = .01). Reconstruction procedures performed with distal clavicle excision showed a higher revision rate, 17% compared to 0% (p = .003). There were no statistically significant clinical differences. AC reconstructions performed with suture button construct were superior to other surgical techniques. Procedures performed with distal clavicle excision were inferior to those without. PMID:23449059

  13. Total Pancreatectomy and Islet Auto-Transplantation in Children for Chronic Pancreatitis. Indication, Surgical Techniques, Post Operative Management and Long-Term Outcomes

    PubMed Central

    Chinnakotla, Srinath; Bellin, Melena D.; Schwarzenberg, Sarah J.; Radosevich, David M.; Cook, Marie; Dunn, Ty B.; Beilman, Gregory J.; Freeman, Martin L.; Balamurugan, A.N.; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J.; Vickers, Selwyn M.; Pruett, Timothy L.; Sutherland, David E.R.

    2014-01-01

    Objective Describe the surgical technique, complications and long term outcomes of total pancreatectomy and islet auto transplantation (TP-IAT) in a large series of pediatric patients. Summary Background Data Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, while islet auto transplantation (IAT) potentially can prevent or minimize TP-related diabetes. Methods Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic or surgical treatment between 1989–2012. Results Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (p =<0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (p=0.032), lack of prior Puestow (p=0.018), lower body surface area (p=0.048), IEQ per Kg Body Weight (p=0.001) and total IEQ (100,000) (0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT:(1) male gender, (2) lower body surface area and the (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (OR = 2.62; p value < 0.001). Conclusions TP-IAT provides sustained pain relief and improved quality of life. The β cell function is dependent on islet yield. TP-IAT is an effective therapy for children with painful pancreatitis that fail medical and or endoscopic management PMID:24509206

  14. Surgical management of presbyopia

    PubMed Central

    Torricelli, André AM; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J

    2012-01-01

    Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages. PMID:23055664

  15. Surgical Skills Beyond Scientific Management.

    PubMed

    Whitfield, Nicholas

    2015-07-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  16. Surgical Skills Beyond Scientific Management

    PubMed Central

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  17. Surgical management of fecal incontinence.

    PubMed

    Bleier, Joshua I S; Kann, Brian R

    2013-12-01

    The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches. PMID:24280402

  18. Surgical Management for Fecal Incontinence

    PubMed Central

    Anandam, Joselin L.

    2014-01-01

    Fecal incontinence is a socially debilitating condition that can lead to social isolation, loss of self-esteem and self-confidence, and depression in an otherwise healthy person. After the appropriate clinical evaluation and diagnostic testing, medical management is initially instituted to treat fecal incontinence. Once medical management fails, there are a few surgical procedures that can be considered. This article is devoted to the various surgical options for fecal incontinence including the history, technical details, and studies demonstrating the complication and success rate. PMID:25320569

  19. Regenerative treatments to enhance orthopedic surgical outcome.

    PubMed

    Murrell, William D; Anz, Adam W; Badsha, Humeira; Bennett, William F; Boykin, Robert E; Caplan, Arnold I

    2015-04-01

    In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes. The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations, growth factors, bone marrow preparations, and stem cells. This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the index procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome. In this review we provide a comprehensive overview of the peer-reviewed evidence-based literature, highlighting the clinical outcomes in humans both with preclinical data and human clinical trials involving regenerative preparations within the areas of rotator cuff, meniscus, ligament, and articular cartilage surgical repair. PMID:25864660

  20. Preliminary Favorable Outcome for Medically and Surgically Managed Extensively Drug-Resistant Tuberculosis, France, 2009–2014

    PubMed Central

    Henry, Benoît; Revest, Matthieu; Dournon, Nathalie; Epelboin, Loïc; Mellon, Guillaume; Bellaud, Guillaume; Mordant, Pierre; Le Dû, Damien; Véziris, Nicolas; Bernard, Christine; Morel, Sébastien; Jauréguiberry, Stéphane; Michelet, Christian; Bricaire, François; Caumes, Éric

    2016-01-01

    We report 20 cases of extensively drug-resistant tuberculosis managed in France. Treatment was individualized and included bedaquiline and linezolid for most patients and surgery in 8 patients. At last follow-up (22 months), 19 patients had achieved conversion from positive to negative on culture testing. These promising results of comprehensive management obtained in a small series deserve confirmation. PMID:26891089

  1. Preliminary Favorable Outcome for Medically and Surgically Managed Extensively Drug-Resistant Tuberculosis, France, 2009-2014.

    PubMed

    2016-03-01

    We report 20 cases of extensively drug-resistant tuberculosis managed in France. Treatment was individualized and included bedaquiline and linezolid for most patients and surgery in 8 patients. At last follow-up (22 months), 19 patients had achieved conversion from positive to negative on culture testing. These promising results of comprehensive management obtained in a small series deserve confirmation. PMID:26891089

  2. Surgical management of ectopic pregnancy.

    PubMed

    Stock, Laura; Milad, Magdy

    2012-06-01

    Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed. PMID:22510627

  3. Can Probiotics Improve Your Surgical Outcomes?

    PubMed

    Ward, Tina; Nichols, Misty; Nutter, Julie

    2016-01-01

    Despite ongoing advances in medical technology, postoperative infections and infectious complications continue to be a significant cause of morbidity and mortality. Surgical trauma and prophylactic antibiotics disrupt the balance of the intestinal microbiota and barrier function of the gut, potentiating an enhanced inflammatory response and further immune system depression. With the increasing costs of health care and emergence of multidrug-resistant bacteria, alternative approaches must be explored. Many clinical studies have demonstrated that the use of probiotics, prebiotics, or a combination of both (synbiotics) as a part of innovative strategies can improve outcomes of elective abdominal and gastrointestinal surgical procedures. It has been demonstrated that probiotics play a role in gut barrier improvement and immunomodulation. However, it is evident that additional research is needed including larger, multicenter, randomized controlled trials to validate the safety and efficacy of their use in surgical patients. The purpose of this article is to discuss background of probiotic use in abdominal/gastrointestinal surgery, risk and benefits, clinical relevance for health care providers, and further implications for research. PMID:27254237

  4. Chronic insertional Achilles tendinopathy: surgical outcomes

    PubMed Central

    Oshri, Yael; Palmanovich, Ezequiel; Brin, Yaron Shagra; Karpf, Ronen; Massarwe, Sabri; Kish, Benny; Nyska, Meir

    2012-01-01

    Summary Background and objective: insertional Achilles tendinopathy is a common condition among athletes and joggers. One fifth of the injuries involves the insertion of the tendon. The etiology is either due to mechanical overuse related to sports activity, or a systemic inflammatory disease. The clinical appearance includes pain and movement restriction. The primary treatment is conservative. The surgery referred to in this study (Calcaneal Osteotomy) is performed by decompression of the posterior margin of the calcaneus. If the tendon is degenerative, debridement is needed. There is controversy on the surgical outcome and the surgical approach. A retrospective analytic observational study. Methods: 20 patients who were diagnosed with IAT (21 feet) and were operated on between the years 2000–2007 by calcaneal osteotomy. Main outcome measures: the primary measure of success was diminished pain. It was demonstrated in the AOFAS score and in the VAS scale of pain. Results: the average grade in the AOFAS questionnaire improved by 20 points, and the average grading of pain in the VAS scale was decreased by 4.21. The median satisfaction rate was 8, the average was 5.81. 62% of the patients would repeat the surgery/recommend it. We found a significant relationship (p=0.022) between patients who avoided sports activity while suffering from insertional Achilles tendinopathy and the satisfaction rate from the surgery. Conclusions: using the calcaneal osteotomy technique as a surgical treatment for IAT is successful, and improves measures of pain and function. Low compliance with avoiding sports activity while suffering from an IAT might lead to a need for surgery. PMID:23738280

  5. Surgical progress: surgical management of infective endocarditis.

    PubMed Central

    Mills, S A

    1982-01-01

    Infective endocarditis of bacterial or fungal origin may arise in either the left or the right heart and can involve both natural and prosthetic valves. The diagnosis is based primarily upon clinical criteria and positive blood cultures, but serial electrocardiograms, fluoroscopy, and two-dimensional echocardiograms may also be helpful. The initial treatment should consist of antibiotic therapy and is itself often adequate in effecting cure. However, careful observation during antibiotic treatment is mandatory, since the development of congestive heart failure due to valvular obstruction or destruction can be an indication for surgical intervention. Other surgical indications include a failure to respond to antibiotic therapy, pulmonary or systemic emboli, evidence of abscess involving the valvular ring (particularly prevalent with prosthetic valve endocarditis), Brucella infection, and the onset of conduction disturbances. The goals of surgical treatment are removal of infective tissue, restoration of valve function, and correction of associated mechanical disorders. The results are surprisingly good, especially for a condition of this severity. Images Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:7065743

  6. Predictors of surgical outcome and their assessment.

    PubMed

    Mannion, Anne F; Elfering, Achim

    2006-01-01

    The relatively high rate of failed back surgery has prompted the search for "risk factors" to predict the result of spinal surgery in a given individual. However, the literature reveals few unequivocal predictors and they often explain a relatively low proportion of variance in outcome. This suggests that we have a long way to go before being able to rest easily, having refused someone surgery on the basis of unfavourable baseline characteristics. The best recommendation is to ensure, firstly, that the indication for surgery is absolutely clear-cut (i.e. that surgically remediable pathology exists) and then to consider the various factors that may influence the "typical" outcome. Consistent risk factors for a poor outcome regarding return-to-work include long-term sick leave/receipt of disability benefit. Hence, every effort should be made to keep the individual in the workforce, despite the ongoing symptoms and plans for surgery. In patients with a particularly heavy job, consultation with occupational physicians might later ease the patient's way back into the workplace. Patients with degenerative disorders and/or comorbidity should be counselled that few of them will have complete/lasting pain relief or a complete return to pre-morbid function. Patients with a high level of distress may benefit from psychological treatment, before and/or accompanying the surgical treatment. The opportunity (time), encouragement (education and positive messages), and resources (referral to appropriate support services) to modify risk factors that are indeed modifiable should be offered, and realistic expectations should be discussed with the patient before the decision to operate is made. PMID:16320033

  7. Surgical Outcome of Intradural Spinal Tumors.

    PubMed

    Ahsan, M K; Sakeb, N; Ali, M Y; Awwal, M A; Khan, S I; Goni, M M; Mia, M B; Alam, M B; Zaman, N; Jannat, S N

    2016-07-01

    Results of 63 surgically treated intradural spinal tumors between the period of October 2003 and December 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, were analyzed retrospectively. There were 33 males, 30 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumors location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The tumors were located as, thoracic (n=32, 50.79%), lumbar (n=16, 25.39%), cervical (n=05, 07.93%), and junctional (n=10, 15.87%, CervicoThoracic-01, Thoracolumbar-09). The histopathological diagnosis included schwannoma (n=30, 47.7%), meningiomas (n=14, 22.3%), neurofibroma, arachnoid cyst and myxopapillary ependymoma (n=03, 04.76%) each and paraganglioma (n=01, 01.59%). Among the intramedullary tumors, ependymoma (n=03, 04.76%), astrocytoma and epidermoid cyst (n=02, 03.17%), haemangioblastoma, paraganglioma and cavernous haemangioma (n=01, 01.59%) each. The VAS score was reduced in all cases from 8.0±1.2 to 1.2±0.8 (p<0.003) and the Nurick's grade was improved in all cases from 3.0±1.3 to 1.0±0.0 (p<0.005). The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia and further neurological deterioration (Astrocytoma) (n=02, 03.17%) and dependant bedsore and recurrence (Ependymoma) (n=01, 01.59%). Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome except intramedullary tumors where initial treatment consists of maximum safe surgical resection or biopsy. PMID:27612900

  8. Current Management of Surgical Oncologic Emergencies

    PubMed Central

    Bosscher, Marianne R. F.; van Leeuwen, Barbara L.; Hoekstra, Harald J.

    2015-01-01

    Objectives For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. Method A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. Results In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. Conclusion In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy. PMID:25933135

  9. Surgical Management of Chronic Pancreatitis.

    PubMed

    Parekh, Dilip; Natarajan, Sathima

    2015-10-01

    Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed. PMID:26722211

  10. Interstitial Ectopic Pregnancy: Conservative Surgical Management

    PubMed Central

    Warda, Hussein; Mamik, Mamta M.; Ashraf, Mohammad

    2014-01-01

    Introduction: Interstitial pregnancy is a rare and life-threatening condition. Diagnosis and appropriate management are critical in preventing morbidity and death. Case Description: Four cases of interstitial pregnancy are presented. Diagnostic laparoscopy followed by laparotomy and cornuostomy with removal of products of conception was performed in 1 case. Laparoscopic cornuostomy and removal of products of conception were performed in the subsequent 3 cases with some modifications of the technique. Subsequent successful reproductive outcomes are also presented. Discussion: Progressively conservative surgical measures are being used to treat interstitial pregnancy successfully, with no negative impact on subsequent pregnancies. PMID:24960482

  11. The surgical management of necrotising enterocolitis (NEC).

    PubMed

    Thakkar, Hemanshoo Sudhir; Lakhoo, Kokila

    2016-06-01

    Necrotising enterocolitis (NEC) is a neonatal surgical emergency. At its early stages, the management of NEC is largely medical using broad-spectrum antibiotics, gut rest and total parental nutrition. The only absolute indication for surgery is an intra-abdominal perforation. There are several relative indications for surgery based on clinical, biochemical and radiological parameters. Once the decision to intervene is made, several approaches may be taken. Peritoneal lavage can be used as a salvage procedure or definitive management in some cases. The most common approach taken is bowel resection with enterostomy formation. There is a role for primary anastomosis of bowel in limited NEC. In severe, multi-focal NEC a high diverting jejunostomy or "clip and drop technique" can be used. Laparoscopy has a limited role and is not widespread. The surgical complications of NEC include stoma related morbidity, anastomotic leak/stricture and short-bowel syndrome. Long-term data on neurodevelopmental outcomes is sparse but the present literature is suggestive of a negative impact in cases of surgically managed NEC. PMID:27032753

  12. Surgical Management of Pediatric Gastroesophageal Reflux Disease

    PubMed Central

    Jackson, Hope T.; Kane, Timothy D.

    2013-01-01

    Gastroesophageal reflux (GER) is common in the pediatric population. Most cases represent physiologic GER and as the lower esophageal sphincter (LES) matures and a solid diet is introduced, many of these patients (>65%) experience spontaneous resolution of symptoms by two years of age. Those who continue to have symptoms and develop complications such as failure to thrive, secondary respiratory disease, and others are classified as having gastroesophageal reflux disease (GERD). Goals of GERD treatment include the resolution of symptoms and prevention of complications. Treatment options to achieve these goals include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. This paper will review the clinical presentation of GERD and discuss options for surgical management and outcomes in these patients. PMID:23762041

  13. Surgical Management of Metastatic Disease.

    PubMed

    Keung, Emily Z; Fairweather, Mark; Raut, Chandrajit P

    2016-10-01

    Sarcomas are rare cancers of mesenchymal cell origin that include many histologic subtypes and molecularly distinct entities. For primary resectable sarcoma, surgery is the mainstay of treatment. Despite treatment, approximately 50% of patients with soft tissue sarcoma are diagnosed with or develop distant metastases, significantly affecting their survival. Although systemic therapy with conventional chemotherapy remains the primary treatment modality for those with metastatic sarcoma, increased survival has been achieved in select patients who receive multimodality therapy, including surgery, for their metastatic disease. This article provides an overview of the literature on surgical management of pulmonary and hepatic sarcoma metastases. PMID:27542649

  14. Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non-Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial

    PubMed Central

    Whang, Peter; Polly, David; Frank, Clay; Lockstadt, Harry; Glaser, John; Limoni, Robert; Sembrano, Jonathan

    2015-01-01

    Background Sacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction. Methods We conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods. Results Subjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority >0.999). Clinically important (≥15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857). Conclusions Six-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more

  15. Aggressive Management of Surgical Emergencies

    PubMed Central

    Bengmark, Stig

    2006-01-01

    Increasing evidence suggests that two factors significantly influence outcome in a surgical emergency – premorbid health and the degree of inflammation during the first 24 h following trauma. Repeat observations suggest that the depth of post-trauma immunoparalysis reflects the height of early inflammatory response. Administration to surgical emergencies, as was routine in the past, of larger amounts of fluid and electrolytes, fat, sugar and nutrients seems counterproductive as it increases immune dysfunction, impairs resistance to disease and, in fact, increases morbidity. Instead, strong efforts should be made to limit the obvious superinflammation, which occurs during the first 24 h after trauma and, thereby, reduce the subsequent immuno-paralysis. paralysis. Several approaches show efficacy in limiting early superinflammation such as strict control of blood glucose, avoida nce of stored blood when possible, supply of antioxidants, live lactic acid bacteria and plant fibres. This review focuses mainly on use of live lactic acid bacteria and plant fibres, often called synbiotics. Encouraging experience is reported from clinical trials in liver transplantation, severe pancreatitis and extensive trauma. Immediate control of inflammation by enteral nutrition and supply of antioxidants, lactic acid bacteria and fibres is facilitated by feeding tubes, introduced as early as possible on arrival at the hospital. PMID:17132308

  16. Surgical Outcomes of High-Grade Spinal Cord Gliomas

    PubMed Central

    Hida, Kazutoshi; Yano, Syunsuke; Aoyama, Takeshi; Koyanagi, Izumi; Houkin, Kiyohiro

    2015-01-01

    Study Design A retrospective study. Purpose The purpose of this study was to obtain useful information for establishing the guidelines for treating high-grade spinal cord gliomas. Overview of Literature The optimal management of high-grade spinal cord gliomas remains controversial. We report the outcomes of the surgical management of 14 high-grade spinal glioma. Methods We analyzed the outcomes of 14 patients with high-grade spinal cord gliomas who were surgically treated between 1989 and 2012. Survival was charted with the Kaplan-Meier plots and comparisons were made with the log-rank test. Results None of the patients with high-grade spinal cord gliomas underwent total resection. Subtotal resection was performed in two patients, partial resection was performed in nine patients, and open biopsy was performed in three patients. All patients underwent postoperative radiotherapy and six patients further underwent radiation cordotomy. The median survival time for patients with high-grade spinal cord gliomas was 15 months, with a 5-year survival rate of 22.2%. The median survival time for patients with World Health Organization grade III tumors was 25.5 months, whereas the median survival time for patients with glioblastoma multiforme was 12.5 months. Both univariate and multivariate Cox proportional hazards models demonstrated a significant effect only in the group that did not include cervical cord lesion as a factor associated with survival (p=0.04 and 0.03). Conclusions The surgical outcome of patients diagnosed with high-grade spinal cord gliomas remains poor. Notably, only the model which excluded cervical cord lesions as a factor significantly predicted survival. PMID:26713128

  17. Clinical Characteristics and Surgical Outcomes in Patients With Intermittent Exotropia

    PubMed Central

    Yang, Min; Chen, Jingchang; Shen, Tao; Kang, Ying; Deng, Daming; Lin, Xiaoming; Wu, Heping; Chen, Qiwen; Ye, Xuelian; Li, Jianqun; Yan, Jianhua

    2016-01-01

    Abstract The clinical characteristics and surgical outcomes in a large sample of patients with intermittent exotropia (IXT) as well as an analysis of risk factors associated with surgical failures are presented in this article. Data from IXT patients who received surgical management at the Eye Hospital, in the Zhongshan Ophthalmic Center, of Sun Yat-Sen University, China from January 2009 to December 2013 were reviewed retrospectively. Included within this analysis were data from pre- and postoperative ocular motility, primary alignment, and binocular vision. A total of 1228 patients with IXT were reviewed. Males (50.4%) and females (49.6%) were nearly equally represented in this sample. Thirty-two patients (2.6%) had a family history of strabismus. The mean age at onset was 6.77 ± 6.43 years (range 7 months –48.5 years), mean duration at presentation was 7.35 ± 6.68 years (range 6 months–47 years), and mean age at surgery was 13.7 ± 8.8 years (range 3–49 years). The mean refractive error was −0.84 ± 2.69 diopter in the right eye and −0.72 ± 2.58 diopter in the left eye. Amblyopia (4.2%), oblique muscle dysfunction (7.0%), and dissociated vertical deviation (4.7%) were also present in these patients. The most common subtype of IXT was the basic type (88.1%). Orthophoria was observed in 80.5% of patients and the ratios of surgical undercorrection and overcorrection were 14.7% and 4.8%, respectively, as determined with a mean follow-up time of 7.8 ± 3.7 months. When combining ocular alignment with binocular vision as the success criteria, the success rate decreased to 35.6%. Multivariate risk factor analysis showed that only the loss of stereoacuity (P = 0.002) was associated with a poor outcome. There were no differences in the long-term results between bilateral lateral rectus recession and unilateral lateral rectus recession with medial rectus resection. Most IXT patients displayed normal vision, with few having positive

  18. Surgical perspectives in the management of atrial fibrillation

    PubMed Central

    Kyprianou, Katerina; Pericleous, Agamemnon; Stavrou, Antonio; Dimitrakaki, Inetzi A; Challoumas, Dimitrios; Dimitrakakis, Georgios

    2016-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge public health burden associated with significant morbidity and mortality. For decades an increasing number of patients have undergone surgical treatment of AF, mainly during concomitant cardiac surgery. This has sparked a drive for conducting further studies and researching this field. With the cornerstone Cox-Maze III “cut and sew” procedure being technically challenging, the focus in current literature has turned towards less invasive techniques. The introduction of ablative devices has revolutionised the surgical management of AF, moving away from the traditional surgical lesions. The hybrid procedure, a combination of catheter and surgical ablation is another promising new technique aiming to improve outcomes. Despite the increasing number of studies looking at various aspects of the surgical management of AF, the literature would benefit from more uniformly conducted randomised control trials. PMID:26839656

  19. Surgical management of presacral bleeding

    PubMed Central

    Ausobsky, JR; Vowden, P

    2014-01-01

    Introduction Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer’s fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding. Methods A systematic search of the MEDLINE® and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis. Results A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature. Conclusions As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding. PMID:24780015

  20. Surgical management of arteriovenous malformation.

    PubMed

    Visser, Anniek; FitzJohn, Trevor; Tan, Swee T

    2011-03-01

    This article presents our experience in managing a series of consecutive patients with arteriovenous malformation (AVM) referred to our Vascular Anomalies Centre over a 14-year period. These patients were culled from our prospective Vascular Anomalies Database 1996-2010. The medical records of these patients were reviewed to supplement the data collected. Out of 1131 patients with vascular anomalies, 53 patients (22 males, 31 females) with AVM were identified. Their mean age was 29 (range: 3-88) years with 14 stage-III, 34 stage-II and five stage-I AVMs, affecting the head and neck area (n=32), lower limb (n=13), upper limb (n=7) and trunk (n=1). Eight patients with eight stage-III and 14 patients with 15 stage-II AVMs underwent definitive surgery following preoperative embolisation in 10 patients. Seventeen patients required reconstruction with free flaps (n=8) or local or regional flaps (n=9), tissue expansion (n=4), tendon recession (n=1), tendon transfer (n=1), osseo-integration (n=1) and skin grafting (n=5). Fourteen patients required a combination of reconstructive techniques. During an average follow-up of 54 (range: 10-135) months, two (8.7%) lesions recurred but were improved following surgery. One patient with life-threatening stage-III AVM underwent 'palliative' surgery following preoperative embolisation and the lesion had improved and remained stable during the 4-year follow-up period. AVM is a challenging clinical problem that requires a multidisciplinary team approach. Complete surgical excision remains the gold-standard treatment and immediate reconstruction is an integral part of definitive surgery for AVM. The heterogeneous nature of AVM requires treatment to be tailored for individual patients and the complex excision defects necessitate expertise in a variety of reconstructive techniques. Our experience shows a recurrence rate of 8.7% following definitive surgery for AVM. PMID:20663728

  1. Surgical Management of Male Voiding Dysfunction.

    PubMed

    Mandeville, Jessica; Mourtzinos, Arthur

    2016-06-01

    Benign prostatic hypertrophy (BPH) is a common cause of voiding dysfunction. BPH may lead to bladder outlet obstruction and resultant troublesome lower urinary tract symptoms. Initial management of BPH and bladder outlet obstruction is typically conservative. However, when symptoms are severe or refractory to medical therapy or when urinary retention, bladder stone formation, recurrent urinary tract infections, or upper urinary tract deterioration occur, surgical intervention is often necessary. Numerous options are available for surgical management of BPH ranging from simple office-based procedures to transurethral operative procedures and even open and robotic surgeries. This article reviews the current, most commonly used techniques available for surgical management of BPH. PMID:27261790

  2. Canine brachycephalic airway syndrome: surgical management.

    PubMed

    Trappler, Michelle; Moore, Kenneth

    2011-05-01

    Many surgical options have been described to treat various aspects of canine brachycephalic airway syndrome (BAS). This article describes the surgical management, postoperative care, and prognosis of this condition. The pathophysiology and medical therapy of BAS are described in a companion article. PMID:21870354

  3. Relation of Surgical Volume to Outcome in Eight Common Operations

    PubMed Central

    Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Hossain, Monir; Soybel, David; Kizer, Kenneth W.; Aust, J. Bradley; Bell, Richard H.; Chong, Vernon; Demakis, John; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Passaro, Edward; Phillips, Lloyd; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

    1999-01-01

    Objective To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care. PMID:10493488

  4. Clinical practice guideline: tonsillitis II. Surgical management.

    PubMed

    Windfuhr, Jochen P; Toepfner, Nicole; Steffen, Gregor; Waldfahrer, Frank; Berner, Reinhard

    2016-04-01

    In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative

  5. Risk-adjusted monitoring of binary surgical outcomes.

    PubMed

    Steiner, S H; Cook, R J; Farewell, V T

    2001-01-01

    A graphical procedure suitable for prospectively monitoring surgical performance is proposed. The approach is based on accumulating evidence from the outcomes of all previous surgical patients in a series using a new type of cumulative sum chart. Cumulative sum procedures are designed to "signal" if sufficient evidence has accumulated that the surgical failure rate has changed substantially. In this way, the chart rapidly detects deterioration (or improvement) in surgical performance while not overreacting to the expected fluctuations due to chance. Through the use of a likelihood-based scoring method, the cumulative sum procedure is adapted so that it adjusts for the surgical risk of each patient estimated preoperatively. The procedure is therefore applicable in situations where it is desirable to adjust for a mix of patients. Signals of the chart lead to investigations of the cause and to the timely introduction of remedial measures designed to avoid unnecessary future failures. PMID:11386623

  6. Hearing Outcomes after Surgical Drainage of Petrous Apex Cholesterol Granuloma.

    PubMed

    Rihani, Jordan; Kutz, J Walter; Isaacson, Brandon

    2015-06-01

    Objective This study aims to assess the hearing outcomes of patients undergoing surgical management of petrous apex cholesterol granuloma and to discuss the role of otic capsule-sparing approaches in drainage of petrous apex cholesterol granulomas. Design Retrospective case series. Setting Tertiary care medical center. Participants Eight patients underwent surgery for presumed or definitive cholesterol granuloma between 2002 and 2011 and met the inclusion criteria for this study. Main Outcome Measures Pre- and postoperative audiogram results as measured by pure tone thresholds and word recognition scores. Results Four patients (50%) demonstrated improvement in speech discrimination. One patient had an increase from 0 to 67% in word recognition scores. Four patients (50%) demonstrated worsening of pure tone thresholds, including two patients with anacusis. Conclusion Perilabyrinthine drainage of petrous apex cholesterol granulomas may result in hearing preservation or hearing improvement, even in the setting of otic capsule erosion. Patients should be counseled about the potential risk of significant hearing loss. PMID:26225297

  7. Hearing Outcomes after Surgical Drainage of Petrous Apex Cholesterol Granuloma

    PubMed Central

    Rihani, Jordan; Kutz, J. Walter; Isaacson, Brandon

    2014-01-01

    Objective This study aims to assess the hearing outcomes of patients undergoing surgical management of petrous apex cholesterol granuloma and to discuss the role of otic capsule–sparing approaches in drainage of petrous apex cholesterol granulomas. Design Retrospective case series. Setting Tertiary care medical center. Participants Eight patients underwent surgery for presumed or definitive cholesterol granuloma between 2002 and 2011 and met the inclusion criteria for this study. Main Outcome Measures Pre- and postoperative audiogram results as measured by pure tone thresholds and word recognition scores. Results Four patients (50%) demonstrated improvement in speech discrimination. One patient had an increase from 0 to 67% in word recognition scores. Four patients (50%) demonstrated worsening of pure tone thresholds, including two patients with anacusis. Conclusion Perilabyrinthine drainage of petrous apex cholesterol granulomas may result in hearing preservation or hearing improvement, even in the setting of otic capsule erosion. Patients should be counseled about the potential risk of significant hearing loss. PMID:26225297

  8. The Impact of Fitness on Surgical Outcomes: The Case for Prehabilitation.

    PubMed

    Myers, Jonathan N; Fonda, Holly

    2016-01-01

    In recent years, a growing body of research has demonstrated that an individual's fitness level is a strong and independent marker of risk for cardiovascular and all-cause mortality. In addition, modest improvements in fitness through exercise intervention have been associated with considerable health outcome benefits. These studies have generally assessed fitness as a baseline marker in traditional epidemiological cohorts. However, there has been a recent recognition that fitness powerfully predicts outcomes associated with a wide range of surgical interventions. The concept of 'prehabilitation' is based on the principle that patients with higher functional capability will better tolerate a surgical intervention, and studies have shown that patients with higher fitness have reduced postoperative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. This review focuses on the impact of fitness on surgical outcomes and provides a rationale in support of routine application of prehabilitation in the management of patients undergoing surgery. PMID:27399826

  9. Contemporary surgical management of rectovaginal fistula in Crohn's disease

    PubMed Central

    Valente, Michael A; Hull, Tracy L

    2014-01-01

    Rectovaginal fistula is a disastrous complication of Crohn’s disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women’s quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula. PMID:25400993

  10. Surgical Management for Peyronie's Disease

    PubMed Central

    Segal, Robert L.

    2013-01-01

    Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations. PMID:23658860

  11. Surgical Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine either previous or current surgical factors noted at the time of ACL revision reconstruction predicts activity level, sports function, and OA symptoms at two year follow-up. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Regression analysis was used to control for age, gender, BMI, activity level, baseline outcome scores, revision number, time since last ACLR, and a variety of previous and current surgical variables, in order to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: 1205 patients met the inclusion criteria and were successfully enrolled. 697 (58%) were males, with a median cohort age of 26 years. The median time since their last ACL reconstruction was 3.4 years. Baseline characteristics of the cohort are summarized in Table 1. At 2 years, follow-up was obtained on 82% (989/1205). Both previous as well as current surgical factors were found to be significant drivers of poorer outcomes at 2 years (Table 2). The most consistent surgical factors driving outcome in revision patients were prior surgical technique, prior tibial tunnel position, current femoral fixation and having a notchplasty. Having a previous arthrotomy compared to the one incision technique resulted in significantly poorer outcomes on the IKDC (odds ratio=0.41; 95% CI=0.17-0.95; p=0.037) and KOOS pain, sports/rec, and QOL subscales (OR range=0.23-0.42; 95% CI=0.10-0.97; p<0

  12. Surgical management of glaucoma: Evolving paradigms

    PubMed Central

    Sharaawy, Tarek; Bhartiya, Shibal

    2011-01-01

    Surgical intervention is mandatory in the case of documentation of the progression of glaucomatous optic neuropathy despite the administration of maximal tolerated medical therapy, and in cases where compliance is poor. Minimal complications, good long-term intraocular pressure (IOP) control, and precisely titrated target IOPs resulting in avoidance of visual impairment are the primary goals of surgical intervention. This article is an attempt to provide a broad overview of the therapeutic options available to the glaucoma surgeon. The available surgical modalities have undergone modifications and refinements over time, with a view to improve patient outcomes and visual recovery, yet are fraught with intra- and postoperative complications. The risk and benefits of each of the available surgical options must be critically evaluated and customized to fit the needs of the particular patient. There is insufficient evidence at present to establish the superiority of any of these surgeries over the other. PMID:21150024

  13. Nonsyndromic craniosynostosis: diagnosis and contemporary surgical management.

    PubMed

    Ruiz, Ramon L; Ritter, Ann M; Turvey, Timothy A; Costello, Bernard J; Ricalde, Pat

    2004-11-01

    Contemporary surgical management of nonsyndromic craniosynostosis requires the combined expertise of a pediatric craniofacial surgeon and pediatric neurosurgeon. The goals of surgical intervention are the release of the affected suture, which allows for unrestricted development of the visceral components (eg, brain, eyes) and three-dimensional reconstruction of the skeletal components, which establishes a more normal anatomic position and contour. Surgeon who care for infants with these cranial and orbital malformations must maintain a thorough understanding of the three-dimensional anatomy, characteristic dysmorphology associated with the different types of synostosis, and the complex interplay that exists between surgical intervention and ongoing skeletal growth. PMID:18088747

  14. A Comprehensive Surgical Procedure in Conservative Management of Placenta Accreta

    PubMed Central

    Kelekci, Sefa; Ekmekci, Emre; Aydogmus, Serpil; Gencdal, Servet

    2015-01-01

    Abstract We aimed to present a combined surgical procedure in conservative treatment of placenta accreta based on surgical outcomes in our cohort of patients. The study was designed as a prospective cohort series study. The setting involved two education and research hospitals in Turkey. This study included 12 patients with placenta accreta who were prenatally diagnosed and managed. We offered the patients the choice of conservative or nonconservative treatment. We then offered 2 choices for patients who had preferred conservative treatment, leaving the placenta in situ as is the classical procedure, or our surgical procedure. One patient preferred nonconservative treatment, the others opted for our procedure. We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes. We operated on 11 patients using this surgical procedure that we have developed for placenta accreta cases. We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients. No patient presented any septic complication or secondary vaginal bleeding. Our surgical procedure seems to be effective and useful in the conservative treatment of placenta accreta. PMID:25700315

  15. Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults

    PubMed Central

    2009-01-01

    Background The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries. Methods Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions. Results The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis. Conclusion Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients. PMID:19627573

  16. The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

    PubMed Central

    Alshameeri, Zeiad A.; Katam, Krishnaiah; Alsamaq, Mohammed; Sonsale, Paresh

    2012-01-01

    Introduction: Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main indications for surgical intervention at our unit and patient satisfaction following surgery. We also wanted to compare the direct and the infraclavicular surgical approaches in relation to the outcome of surgical intervention. Materials and Methods: Retrospective study looking at all the clavicle fractures managed surgically over 5 years at our department. Information relating to surgical indication, surgical approach, complications, outcome, patient satisfaction, and oxford shoulder score were collected. Results: A total of 35 patients were identified, the majority were males (n = 25) and most (n = 29) were working at the time of injury. The commonest indication for surgery was displacement with shortening (n = 16). The infraclavicular approach was used in the majority of patients (n = 21), the rest (n = 14) had direct incision. Evidence of radiological and union was achieved in all patients after an average of 13 (8-24) weeks. There were no major complications but minor complications were reported in 28% and 19% of cases with direct and infraclavicular approaches, respectively. Plates were removed from six symptomatic patients; infraclavicular (n = 2) and direct approach (n = 4). Four asymptomatic plates were removed on patients’ requests. All patients returned to work (after an average 2.6 months), had good oxford shoulder score between 12-20, regardless of the surgical approach used. All patients except one would recommend it to a friend. Conclusion: Our study showed

  17. Exploratory Evaluation of Surgical Skills Mentorship Program Design and Outcomes

    ERIC Educational Resources Information Center

    Gagliardi, Anna R.; Wright, Frances C.

    2010-01-01

    Introduction: There are few opportunities for mentorship of practicing surgeons and no evidence to guide the design of such programs. This study explored outcomes and barriers associated with the design of surgical mentorship programs. Methods: Interviews were held with organizers, mentors, and proteges of 2 programs. Data from 23 participant…

  18. Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment.

    PubMed

    Gurler, Bulent; Coskun, Erol; Öner, Veysi; Comez, Aysegul; Erbagci, Ibrahim

    2016-08-01

    The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD. PMID:26627689

  19. Surgical management of oesophageal atresia.

    PubMed

    Teague, Warwick J; Karpelowsky, Jonathan

    2016-06-01

    There have been major advances in the surgery for oesophageal atresia (OA) and tracheo-oesophageal fistula(TOF) with survival now exceeding 90%. The standard open approach to OA and distal TOF has been well described and essentially unchanged for the last 60 years. Improved survival in recent decades is most attributable to advances in neonatal anaesthesia and perioperative care. Recent surgical advances include the use of thoracoscopic surgery for the repair of OA/TOF and in some centres isolated OA, thereby minimising the long term musculo-skeletal morbidity associated with open surgery. The introduction of growth induction by external traction (Foker procedure) for the treatment of long-gap OA has provided an important tool enabling increased preservation of the native oesophagus. Despite this, long-gap OA still poses a number of challenges, and oesophageal replacement still may be required in some cases. PMID:27217220

  20. Surgical management of intracerebral hematomas

    SciTech Connect

    Tsementzis, S.A.

    1985-04-01

    Traditional and recent developments in the management of spontaneous intracranial hematomas are reviewed. A comprehensive account of the epidemiological characteristics worldwide with an etiological analysis including prevention and prophylaxis introduce the size and clinical significance of this neurological problem. The usefulness and limitations of the available diagnostic methods are described. Most of the emphasis, however, is placed on the management and medicosurgical treatment of intracranial hematomas in correlation with their clinical presentation and localization. 80 references.

  1. Outcomes management in women's health.

    PubMed

    Houston, S; Fleschler, R

    1997-01-01

    Outcomes management uses a quality and research approach to reducing costs in health care. Populations may be targeted for high volumes or their potential for cost savings. Outcomes are identified and measured through data collection and analysis. System and care processes that drive these outcomes are analyzed. Tenets related to outcomes management include questioning practice, administrative and physician involvement; recognizing that change is necessary; accepting uncontrollable factors; and valuing the outcomes management process. Resources necessary for managing outcomes include the use of collaborative practice teams, outcomes assessment, information systems, and educational support services. The women's health population can benefit from an outcomes management effort by improving and standardizing care for mothers and infants across the continuum. There is the opportunity to affect the wellness of this population even before the pregnancy occurs. PMID:9170599

  2. [Long-term outcome of surgically treated teratology of Fallot].

    PubMed

    Ben Khalfallah, Ali; Annabi, N; Ousji, Monia

    2004-01-01

    Tetralogy of Fallot is the most common cyanotic congenital heart disease. The surgical treatment that is palliative or complete repair has allowed to transform the preview of this heart disorder. We suggests to study the long term outcome in patients undergoing surgical repair of tetralogy of Fallot, by emphasizing the quality of their lives, the complications, as well as the mortality. Ventricular arrhythmia and sudden cardiac death after repair of tetralogy of Fallot are devastating complications in adults survivors and their prediction remains difficult. PMID:15127696

  3. [Cryptorchidism: guidelines for surgical management].

    PubMed

    Sapin, E

    2014-01-01

    Cryptorchidism is one of the commonest congenital anomalies in the male genitalia, affecting 3 to 5% of male full-term neonates. It is a known cause of infertility associated with a greater risk of development of germ cell tumor. The benefits of early orchidopexy include psychological affects, prevention of testicular degeneration and decrease in the risk of testicular cancer. Laparoscopy is the best way to diagnose and manage intra-abdominal testes. PMID:24139390

  4. Meniscal allograft transplantation: preoperative assessment, surgical considerations, and clinical outcomes.

    PubMed

    Mascarenhas, Randy; Yanke, Adam B; Frank, Rachel M; Butty, Davietta C; Cole, Brian J

    2014-12-01

    The purpose of this review is to characterize the preoperative assessment of meniscal allograft transplantation (MAT) candidates, to detail MAT surgical techniques, and to evaluate current clinical outcome data on MAT. The MAT candidate is typically less than 50 years old and has a history of knee injury, previous meniscus surgery, and persistent pain. Physical exam generally reveals knee pain with joint line tenderness with normal radiographs and magnetic resonance imaging demonstrating the postmeniscectomized state. There are several common surgical techniques used for transplantation, with fixation achieved through sutures, bony fixation, or a combination of the two. Concomitant procedures such as anterior cruciate ligament reconstruction, osteotomy, and other cartilage procedures are commonly performed. The available short- and long-term studies of clinical outcomes of MAT are variable and difficult to effectively compare due to heterogeneity of the study population and available treatment techniques. In addition, there are no published randomized controlled trials. However, recent reviews and cohort studies of clinical outcomes following MAT have shown that whether performed in isolation or performed with concomitant articular cartilage, realignment, or soft tissue reconstruction procedures MAT outcomes have been acceptable with the majority of studies reporting improved clinical outcomes regardless of the scoring system employed. MAT has proven to be a safe and effective technique in reducing knee pain and improving function in the symptomatic meniscal deficient knee. Evaluation of long-term clinical outcomes is necessary as is evaluation of meniscal replacement alternatives. PMID:24951950

  5. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

    PubMed

    Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

    2014-09-01

    Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. PMID:24485271

  6. Surgical management of aneurysmal subarachnoid hemorrhage.

    PubMed

    Colby, Geoffrey P; Coon, Alexander L; Tamargo, Rafael J

    2010-04-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a common and often devastating condition that requires prompt neurosurgical evaluation and intervention. Modern management of aSAH involves a multidisciplinary team of subspecialists, including vascular neurosurgeons, neurocritical care specialists and, frequently, neurointerventional radiologists. This team is responsible for stabilizing the patient on presentation, diagnosing the offending ruptured aneurysm, securing the aneurysm, and managing the patient through a typically prolonged and complicated hospital course. Surgical intervention has remained a definitive treatment for ruptured cerebral aneurysms since the early 1900s. Over the subsequent decades, many innovations in microsurgical technique, adjuvant maneuvers, and intraoperative and perioperative medical therapies have advanced the care of patients with aSAH. This report focuses on the modern surgical management of patients with aSAH. Following a brief historical perspective on the origin of aneurysm surgery, the topics discussed include the timing of surgical intervention after aSAH, commonly used surgical approaches and craniotomies, fenestration of the lamina terminalis, intraoperative neurophysiological monitoring, intraoperative digital subtraction and fluorescent angiography, temporary clipping, deep hypothermic cardiopulmonary bypass, management of acute hydrocephalus, cerebral revascularization, and novel clip configurations and microsurgical techniques. Many of the topics highlighted in this report represent some of the more debated techniques in vascular neurosurgery. The popularity of such techniques is constantly evolving as new studies are performed and data about their utility become available. PMID:20380967

  7. Acute surgical management in idiopathic intracranial hypertension

    PubMed Central

    Zakaria, Zaitun; Fenton, Eoin; Sattar, Muhammad Taufiq

    2012-01-01

    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation. PMID:23239783

  8. Surgical management of silicone mastitis.

    PubMed

    Wustrack, K O; Zarem, H A

    1979-02-01

    The results of the operative treatment of 22 cases of silicone mastitis are presented. Moderate involvement can usually be managed successfully by local excision of the masses, or by a subcutaneous mastectomy with later reconstruction. Patients with severe skin infiltration and/or pectoral muscle involvement are prone to complications, however, and we now believe an aggressive approach--such as a complete mastectomy with nipple banking and excision of the infiltrated muscle, might be best. This would allow the later reconstruction to proceed in relatively uninvolved tissue, and prevent the problems of recurrent inflammation from placing bag-gel prostheses in a residual bed of silicone-infiltrated tissue. PMID:570284

  9. A critical analysis of the surgical outcomes for the treatment of Peyronie’s disease

    PubMed Central

    Mandava, Sree H.; Trost, Landon W.; Hellstrom, Wayne J.G.

    2013-01-01

    Peyronie’s disease (PD) is a relatively common condition, which can impair sexual function and result in emotional and psychological distress. Despite an abundance of minimally invasive treatments, few have confirmed efficacy for improving penile curvature and function. Surgical therapies include many different techniques and are reserved for patients with stable disease of ⩾12 months’ duration. We searched PubMed for all articles from 1990 to the present relating to the surgical management of PD. Preference was given to recent articles, larger series, and those comparing various techniques and/or materials. Outcomes were subsequently analysed and organised by surgical technique and the graft material used. Available surgical techniques include plication/corporoplasty procedures, incision and grafting (I&G), and placing a penile prosthesis with or without adjunctive procedures. Although several surgical algorithms have been reported, in general, plication/corporoplasty procedures are reserved for patients with adequate erectile function, simple curvatures of <60°, and with no deformities (hour-glass, hinge). I&G are reserved for complex curvatures of >60° and those with deformities. Penile prostheses are indicated for combined erectile dysfunction and PD. Overall outcomes show high rates of improved curvature and patient satisfaction, with mildly decreased erectile function with both plication and the I&G procedure (I&G >plication) and decreases in penile length (plication >I&G). Surgical management of PD remains an excellent treatment option for patients with penile curvature precluding or impairing sexual activity. Surgical algorithms are available to assist treating clinicians in appropriately stratifying surgical candidates. Additional research is needed to identify optimal surgical techniques and materials based on patient and disease characteristics. PMID:26558094

  10. Surgical management in patient with uveitis

    PubMed Central

    Murthy, Somasheila I; Pappuru, Rajeev Reddy; Latha, K Madhavi; Kamat, Sripathi; Sangwan, Virender S

    2013-01-01

    Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications. PMID:23803480

  11. Quality of Communication in Robotic Surgery and Surgical Outcomes

    PubMed Central

    Schiff, Lauren; Aoun, Joelle; Taylor, Andrew; Theoharis, Evan; Eisenstein, David

    2016-01-01

    Background and Objectives: Robotic surgery has introduced unique challenges to surgical workflow. The association between quality of communication in robotic-assisted laparoscopic surgery and surgical outcomes was evaluated. Methods: After each gynecologic robotic surgery, the team members involved in the surgery completed a survey regarding the quality of communication. A composite quality-of-communication score was developed using principal component analysis. A higher composite quality-of-communication score signified poor communication. Objective parameters, such as operative time and estimated blood loss (EBL), were gathered from the patient's medical record and correlated with the composite quality-of-communication scores. Results: Forty robotic cases from March through May 2013 were included. Thirty-two participants including surgeons, circulating nurses, and surgical technicians participated in the study. A higher composite quality-of-communication score was associated with greater EBL (P = .010) and longer operative time (P = .045), after adjustment for body mass index, prior major abdominal surgery, and uterine weight. Specifically, for every 1-SD increase in the perceived lack of communication, there was an additional 51 mL EBL and a 31-min increase in operative time. The most common reasons reported for poor communication in the operating room were noise level (28/36, 78%) and console-to-bedside communication problems (23/36, 64%). Conclusion: Our study demonstrates a significant association between poor intraoperative team communication and worse surgical outcomes in robotic gynecologic surgery. Employing strategies to decrease extraneous room noise, improve console-to-bedside communication and team training may have a positive impact on communication and related surgical outcomes. PMID:27493469

  12. Dysphagia lusoria: extrathoracic surgical management

    PubMed Central

    Taylor, Michael; Harris, Kenneth A.; Casson, Alan G.; DeRose, Gaetano; Jamieson, William G.

    1996-01-01

    Objective To report a case of dysphagia lusoria managed by an extrathoracic approach. Design Case report and literature review. Setting A university hospital. Patient A 39-year-old man, who presented with weight loss and dysphagia. Aortography and computed tomography revealed an aberrant subclavian artery compressing the esophagus against the aortic arch. Intervention The right subclavian artery was divided at its origin and reimplanted onto the right carotid artery. The operation was performed through a right supraclavicular incision without opening the chest. Results There was no operative morbidity. Six months postoperatively the patient was asymptomatic and had gained weight. There was no radiologic evidence of esophageal compression. Conclusions Based on the results of our case of dysphagia lusoria and the reports of others that have started to appear in the literature, consideration should be given to repairing a symptomatic, nonaneurysmal aberrant right subclavian artery through an extrathoracic approach. PMID:8599791

  13. Managing anxiety in the elective surgical patient.

    PubMed

    Pritchard, Michael John

    Patients coming into hospital can suffer a great deal of anxiety--Mathews et al (1981) suggested patients who undergo surgery experience acute psychological distress in the pre-operative period. These fears manifest themselves as uncertainty, loss of control and decreased self-esteem, anticipation of postoperative pain, and fear of separation from family (Egan et al, 1992; Asilioglu and Celik, 2004). As technical advances and improved anaesthetic techniques become available to the NHS, the ability to offer day surgery to a wider patient population is increasing. In fact Bernier et al (2003) and Elliott et al (2003) have suggested that 60% of future operations will be day procedures. This means as health-care professionals, nurses will have shorter time available not only to identify patients who may be experiencing anxiety, but also to offer them the support they need to cope with the surgery. Anxiety can have a profound effect on patients--it affects them in a variety of ways, from ignoring the illness, which could have a serious impact on the patient's life, to the constant demand for attention which can take the nurse away from the care of other patients on the ward (Thomas et al, 1995). Recently, there has been increasing interest in the possible influences of properative anxiety on the course and outcome of surgical procedures and the potential benefits of anxiety-reducing interventions (Markland et al, 1993). Caumo et al (2001) suggested that pre-operative management of a patients anxiety would be improved if health-care professionals had more knowledge about the potential predictors of pre-operative anxiety. PMID:19373185

  14. Surgical outcome of spelenectomy in Thalassemia major in children

    PubMed Central

    Akhtar, Ikramullah Khan; Ashraf, Muhammad; Khalid, Irum Uzma; Hussain, Mukhtar

    2016-01-01

    Objective: To determine the surgical outcome of splenectomy in children with thalassemia major. Methods: It is an observational and descriptive study conducted in Department of Paediatric Surgery in collaboration with hematology, radiology, anesthesia and paediatric intensive care department at The Children’s Hospital and the Institute of Child Health, Multan during the period of September 2007 to September 2013. A total of 50 patients suffering from thalassemia major already diagnosed and under management reffered from haematology department for splenectomy were included in this study. After admission, patients were assessed on the basis of history, clinical examination, and necessary investigations before surgery and later on follow-up. Investigations carried were CBC, PT, APTT, Viral markers, ECG, X-ray Chest, abdominal ultrasonography and ECHO if necessary. Splenectomy was performed after prophylactic vaccination against post splenectomy infections. Follow up was performed for at least two years. Blood transfusion requirements and number of hospital visits per annum before and after splenectomy were calculated and results analyzed statistically using SPSS-20. Results: Fifty patients were included in this study. Out of these fifty, 43 (86%) male and 7(14%) were female with a mean age of 9 years. Average blood transfusion requirement was 250 ml/kg/year, interval of blood transfusion was two weeks and twenty five visits per year before splenectomy. After splenectomy, requirement of blood transfusion reduced to 125ml/kg/year, interval between transfusion increased to one month and hospital visits reduced up to twelve per year. Conclusion: Blood transfusion requirement and number of hospital visits per year are decreased and interval between transfusions is increased after splenectomy. Splenectomy should not be delayed when indicated. Preoperative vaccination decreases the chance of post splenectomy infection. PMID:27182228

  15. Surgical challenges and outcomes of rhegmatogenous retinal detachment in albinism.

    PubMed

    Sinha, M K; Chhablani, J; Shah, B S; Narayanan, R; Jalali, S

    2016-03-01

    PurposeTo report the outcomes and surgical difficulties during rhegmatogenous retinal detachment (RRD) repair in patients with albinism.MethodsRetrospective analysis of 10 eyes of 9 patients with albinism that underwent RRD repair was performed. Collected data included demographic details, preoperative examination details, surgical procedure, surgical difficulties, anatomical, and visual outcomes. Outcome measures were retinal reattachment and visual acuity at the last follow-up.ResultsMean preoperative best-corrected visual acuity (BCVA) was logMAR (Logarithm of the Minimum Angle of Resolution) 2.15 (range 0.9-3.0) with preoperative localization of causative break in six eyes. One eye had proliferative vitreoretinopathy grade C1 preoperatively. Four eyes underwent scleral buckling (SB) and six underwent 20G pars plana vitrectomy (PPV) with silicone oil injection. Intraoperative complication as iatrogenic retinal break occurred in four eyes. For retinopexy during vitrectomy, endolaser delivery was possible in three out of six eyes, whereas three eyes had cryopexy. The mean follow-up was 12 months in SB group (range 1-12; median 12 months) and 5.33 months (range 1-12; median 3 months) in PPV group. Among vitrectomized eye, two eyes had recurrence at 3 months with oil in situ. Rest of the eyes had attached retina at last follow-up. Mean BCVA at last follow-up was logMAR -1.46 (range 0.7-2.0) with mean improvement of -0.57 logMAR.ConclusionsIdentification of break, induction of posterior vitreous detachment, and endolaser delivery may be difficult during RRD repair in patients with albinism. The incidence of PVR appeared less in these eyes. Both SB and PPV were efficacious and appear to be good surgical techniques for use in this patient population. PMID:26611845

  16. Long term gait outcomes of surgically treated idiopathic toe walkers.

    PubMed

    McMulkin, Mark L; Gordon, Andi B; Tompkins, Bryan J; Caskey, Paul M; Baird, Glen O

    2016-02-01

    Toe walking is a common gait deviation which in the absence of a known cause is termed idiopathic toe walking. Surgical treatment in the presence of a triceps surae contracture includes tendo-Achilles or gastrocnemius/soleus recession and has been shown to be effective in improving kinematic outcomes at a one year follow up. The purpose of this study was to assess longer term kinematic and kinetic outcomes of children with idiopathic toe walking treated surgically for gastrocnemius/soleus contractures. Eight subjects with a diagnosis of idiopathic toe walking who had surgical lengthening of the gastrocnemius/soleus and had previous motion analysis laboratory studies pre-operative and 1 year post-operative, returned for a motion analysis laboratory study greater than 5 years since surgery. Subjects completed lower extremity physical exam and 3-D computerized kinematics and kinetics. Significant improvements for mean pelvic tilt, peak dorsiflexion in stance and swing, and overall kinematics index at 1 year post-operative were maintained at 5 years post-operative. Kinetic variables of ankle moment and power were improved at 1 year and 5 years post-operative. On physical exam, dorsiflexion with knee extended was tighter from 1 to 5 year follow-up which did not correspond to the functional changes of gait. Idiopathic toe walkers who were treated surgically for triceps surae contractures showed significant improvements in key kinematic and kinetic gait analysis variables at 1 year post-operative that were maintained at 5 years post-operative. Overall, subjects were satisfied with outcomes of the surgery, unrestricted in activities, and reported minimal pain. PMID:27004661

  17. Surgical Outcome of Medial Rectus Resection in Recurrent Exotropia: A Novel Surgical Formula

    PubMed Central

    Luk, Abbie Sheung-Wan; Yam, Jason Cheuk-Sing; Lau, Henry Hing-Wai; Yip, Wilson Wai-Kuen; Young, Alvin Lerrmann

    2015-01-01

    Purpose. To evaluate the surgical outcomes of unilateral or bilateral medial rectus (MR) muscle resection for recurrent exotropia after bilateral lateral rectus (BLR) muscle recession based on a novel surgical formula. Methods. Forty-one consecutive patients with unilateral or bilateral MR muscle resection for recurrent exotropia after BLR muscle recession were included in this retrospective study. All surgeries were performed according to the formula: 1.0 mm MR muscle resection for every 5 prism dioptres (PD) of exotropia, with an addition of 0.5 mm to each MR muscle operated on. Results. The mean recurrent exotropia distant deviation was 28 PD ± 11.2 (range 14 to 55 PD). Overall at postoperative 1 month, 36 (88%) achieved successful outcomes, 4 (10%) had undercorrection, and 1 (2%) had overcorrection. At postoperative 6 months, 29 (71%) achieved successful outcomes, 12 (29%) had undercorrection, and none had overcorrection. Subgroup analysis showed no statistically significant difference in success rates between unilateral and bilateral MR groups. Conclusion. Unilateral or bilateral MR muscle resection using our surgical formula is a safe and effective method for calculating the amount of MR resection in moderate to large angle recurrent exotropia, with a low overcorrection rate. PMID:25866673

  18. High-risk prostate cancer: the role of surgical management.

    PubMed

    Morlacco, Alessandro; Karnes, R Jeffrey

    2016-06-01

    High-risk prostate cancer (HR Pca) is a highly heterogeneous disease from a biological and clinical standpoint, and it carries a significant chance of morbidity and mortality. Despite the impact of PSA screening, a significant number of men continue to present with high risk disease and need adequate management: clinical evidence shows that a considerable fraction on men with HR PCa can be actually cured with either uni- or multi-modality approaches. Surgical treatment, once considered unfeasible in this setting, is acquiring more and more diffusion in modern clinical practice. Herein we discuss the main treatment strategies for high-risk prostate cancer, providing an expert opinion on the role of surgical management and its outcomes in the most recent literature. PMID:27155934

  19. Management and outcome of low anorectal malformations.

    PubMed

    Pakarinen, Mikko P; Rintala, Risto J

    2010-11-01

    Low anorectal malformation comprises about half of all anorectal anomalies. Most of the literature concerning management of anorectal anomalies is centred around the treatment and outcome of high anomalies. The management of low anomalies has been considered significantly less challenging than high anomalies. Also, the outcome of low anomalies has traditionally been considered good. However, recent more critical long-term follow-up reports show a different picture. Many patients with low anomalies suffer from long-term anorectal functional problems, especially constipation but also soiling that occurs in a significant percentage of patients. In this review, we compile the recent views on the diagnosis, surgical treatment and outcome of low anorectal anomalies. We also present an algorithm for the management of these anomalies. The emphasis on the surgical management of low anorectal anomalies is to use as minimally invasive operative methods as possible and preserve the native mechanisms of continence that usually are much better preserved than in more severe high anomalies. PMID:20845044

  20. Rathke's cleft cysts: review of natural history and surgical outcomes.

    PubMed

    Han, Seunggu J; Rolston, John D; Jahangiri, Arman; Aghi, Manish K

    2014-04-01

    Rathke's cleft cysts (RCCs), also known as pars intermedia cysts, represent benign lesions formed from remnants of the embryologic Rathke's pouch. Commonly asymptomatic, they are identified in nearly 1 in 6 healthy volunteers undergoing brain imaging. When symptomatic, they can cause headaches, endocrine dysfunction, and, rarely, visual disturbances. A systematic review of the published English literature was performed focusing on large modern case series of RCCs to describe their natural history, clinicopathologic features, radiographic features, and surgical outcomes, including rates of recurrence. The natural history of asymptomatic RCCs is one of slow growth, suggesting that observation through serial magnetic resonance imaging is appropriate for smaller asymptomatic RCCs. Symptomatic RCCs can be treated by surgical resection with low morbidity, usually through an endonasal transsphenoidal corridor using either a microscope or an endoscope. Surgical treatment frequently provides symptomatic relief of headaches and visual disturbances, and sometimes even improves endocrine dysfunction. Rates of recurrence after surgical treatment range from 16 to 18 % in large series, and higher rates of recurrence are associated with suprasellar location, inflammation and reactive squamous metaplasia in the cyst wall, superinfection of the cyst, and use of a fat graft into the cyst cavity. PMID:24146189

  1. Surgical management of soft tissue sarcomas

    SciTech Connect

    Arlen, M.; Marcove, R.C.

    1987-01-01

    This volume reflects the latest thinking in surgical and adjuvant forms of therapy that can be offered to the sarcoma patient. Based on their analysis of sarcoma patients, the authors stress management based on site of origin, and discuss tumors on and about the shoulder girdle, hip joint, extremity, retroperitoneum, etc. Coverage includes methods for limb preservation; techniques for regional node resection; indications and methods for arterial perfusion, cryosurgery and isotope implantation; pre- and post-operative immunotherapy chemotherapy and radiation therapy.

  2. Medical and Surgical Management of Male Infertility

    PubMed Central

    Sadri-Ardekani, Hooman

    2014-01-01

    This article is the review of the book “Medical & Surgical Management of Male Infertility” edited by Botros RMB Rizk, Nabil Aziz, Ashok Agarwal and Edmund Sabanegh Jr. This book (hardcover) was published by Jaypee Brothers Medical Publishing, New Delhi.London.Philadelphia.Panama on September 2013 (1st edition). The contents of the book and its relevance to medical education are discussed in this invited review.

  3. Development and validation of the Surgical Outcome Risk Tool (SORT)

    PubMed Central

    Protopapa, K L; Simpson, J C; Smith, N C E; Moonesinghe, S R

    2014-01-01

    Background Existing risk stratification tools have limitations and clinical experience suggests they are not used routinely. The aim of this study was to develop and validate a preoperative risk stratification tool to predict 30-day mortality after non-cardiac surgery in adults by analysis of data from the observational National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Knowing the Risk study. Methods The data set was split into derivation and validation cohorts. Logistic regression was used to construct a model in the derivation cohort to create the Surgical Outcome Risk Tool (SORT), which was tested in the validation cohort. Results Prospective data for 19 097 cases in 326 hospitals were obtained from the NCEPOD study. Following exclusion of 2309, details of 16 788 patients were analysed (derivation cohort 11 219, validation cohort 5569). A model of 45 risk factors was refined on repeated regression analyses to develop a model comprising six variables: American Society of Anesthesiologists Physical Status (ASA-PS) grade, urgency of surgery (expedited, urgent, immediate), high-risk surgical specialty (gastrointestinal, thoracic, vascular), surgical severity (from minor to complex major), cancer and age 65 years or over. In the validation cohort, the SORT was well calibrated and demonstrated better discrimination than the ASA-PS and Surgical Risk Scale; areas under the receiver operating characteristic (ROC) curve were 0·91 (95 per cent c.i. 0·88 to 0·94), 0·87 (0·84 to 0·91) and 0·88 (0·84 to 0·92) respectively (P < 0·001). Conclusion The SORT allows rapid and simple data entry of six preoperative variables, and provides a percentage mortality risk for individuals undergoing surgery. PMID:25388883

  4. Surgical treatment for nasal polyposis: predictors of outcome.

    PubMed

    Grgić, Marko Velimir; Ćupić, Hrvoje; Kalogjera, Livije; Baudoin, Tomislav

    2015-12-01

    Nasal polyps recur in approximately one-third of patients after surgical treatment. It would be beneficial to be able to predict the patients in whom we might expect recurrence and to predict the clinical outcome after surgery. The study included 30 patients operated for nasal polyps. Removed polyps were analyzed by immunohistochemical analysis for IL-5, IgE, vascular endothelial growth factor and eosinophilic infiltration. These parameters together with preoperative CT score were used as independent variables, and subjective score improvement after 2 years was used as a dependent variable in multiple linear regression analysis. Furthermore, the patients were divided into two groups: low and high polyp tissue immunoreactivity. The Chi-squared test was used to determine whether polyp immunoreactivity influences polyp recurrence and subjective score. Preoperative CT score had a slightly positive correlation with subjective score after 2 years. High eosinophil infiltration significantly predicted a higher risk for polyp recurrence. High IL-5 positivity was related to greater risk for polyp recurrence than low IL-5 reactivity but not significantly. IgE and VEGF reactivity in polyp specimens did not have any effect on polyp recurrence. High eosinophilic infiltration in polyps can predict worse outcome after surgical treatment of chronic rhinosinusitis with nasal polyposis. IgE and VEGF do not have prognostic significance to polyp recurrence after surgery. The preoperative extent of disease measured by CT score had a slightly positive correlation with worse outcome after surgery. PMID:25634061

  5. Surgical Treatment and Clinical Outcome of Nonfunctional Pancreatic Neuroendocrine Tumors

    PubMed Central

    Yang, Min; Zeng, Lin; Zhang, Yi; Su, An-ping; Yue, Peng-ju; Tian, Bo-le

    2014-01-01

    Abstract Our primary aim of the present study was to analyze the clinical characteristics and surgical outcome of nonfunctional pancreatic neuroendocrine tumors (non-F-P-NETs), with an emphasis on evaluating the prognostic value of the newly updated 2010 grading classification of the World Health Organization (WHO). Data of 55 consecutive patients who were surgically treated and pathologically diagnosed as non-F-P-NETs in our single institution from January 2000 to December 2013 were retrospectively collected. This entirety comprised of 55 patients (31 males and 24 females), with a mean age of 51.24 ± 12.95 years. Manifestations of non-F-P-NETs were nonspecific. Distal pancreatectomy, pancreaticoduodenectomy, and local resection of pancreatic tumor were the most frequent surgical procedures, while pancreatic fistula was the most common but acceptable complication (30.3%). The overall 5-year survival rate of this entire cohort was 41.0%, with a median survival time of 60.4 months. Patients who underwent R0 resections obtained a better survival than those who did not (P < 0.005). As for the prognostic analysis, tumor size and lymph invasion were only statistically significant in univariate analysis (P = 0.046 and P < 0.05, respectively), whereas the newly updated 2010 grading classification of WHO (G1 and G2 vs G3), distant metastasis, and surgical margin were all meaningful in both univariate and multivariate analysis (P = 0.045, 0.001, and 0.042, respectively). Non-F-P-NETs are a kind of rare neoplasm, with mostly indolent malignancy. Patients with non-F-P-NETs could benefit from the radical resections. The new WHO criteria, distant metastasis and surgical margin, might be independent predictors for the prognosis of non-F-P-NETs. PMID:25396335

  6. Single Stage Surgical Outcomes for Large Angle Intermittent Exotropia

    PubMed Central

    Yang, Min; Chen, Jingchang; Shen, Tao; Kang, Ying; Deng, Daming; Lin, Xiaoming; Wu, Heping; Chen, Qiwen; Ye, Xuelian; Li, Jianqun; Yan, Jianhua

    2016-01-01

    Although there were many prior studies about exotropia, few focused on large-angle intermittent exotropia. The goal of this study was to evaluate single-stage surgical outcomes for large-angle intermittent exotropia and analyze risk factors that may affect the success of surgery. Records from intermittent exotropia patients with exodeviations >60 prism diopters(PD) who were surgically treated at the Zhongshan Ophthalmic Center, of Sun Yat-Sen University were reviewed. Included within this review were data on, pre- and post-operative ocular motility, primary alignment, binocular vision and complications. Patients with exodeviations ≤70PD received two-muscle surgery, while those with exodeviations >70PD were subjected to a three-muscle procedure. A total of 40 records were reviewed. The mean exodeviation was 73±9PD at distance and 75±26PD at near. There were 25 patients received two-muscle surgery and 15 the three-muscle procedure. Orthophoria (deviation within 8PD) was obtained in 77.5% of these patients and the ratios of surgical under-correction and over-correction were 15% and 7.5% respectively. However, when combining ocular alignment with binocular vision as the success criteria, success rates decreased to 30%. No statistically significant differences in success rates were obtained between the two- and three-muscle surgery groups. Seven subjects experienced an abduction deficit during the initial postoperative stages, but eventually showed a full recovery. One patient required a second surgery for overcorrection. No statistically significant risk factors for poor outcome were revealed. Our data showed that single-stage two- and three-muscle surgeries for large-angle intermittent exotropia are effective in achieving a favorable outcome. PMID:26919493

  7. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma

    PubMed Central

    Mierlo, Camille Van; Pinto, Luis Abegão

    2015-01-01

    ABSTRACT Introduction: Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. Methods: Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. Results: Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. Conclusion: IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32. PMID:26997830

  8. Surgical management of the elderly elbow.

    PubMed

    Gibbs, V N; Middleton, R; Rees, J L

    2016-09-01

    The elbow has a major role in helping with the positioning of the hand in space. Any pathology of the joint can result in pain, loss of function and difficulties with activities of daily living. With an increasingly elderly population the degenerative conditions affecting the elbow are becoming more prevalent. Besides traumatic injury, the more commonly encountered problems are osteoarthritis, inflammatory arthritis, nerve compression and stiffness. An awareness of these conditions is important for those who provide care to this patient group. Whilst many of these conditions can be managed conservatively in primary care, some patients are referred to secondary care and elect for surgical treatments. This review considers the surgical treatments for the common elbow pathologies in the elderly population, including the potential complications associated with such treatments. PMID:27451319

  9. Bariatric surgery: three surgical techniques, patient care, risks, and outcomes.

    PubMed

    McGraw, Carrie A; Wool, Daniel B

    2015-08-01

    The prevalence of obesity in the United States is a serious health concern. Bariatric surgery is a recognized and accepted approach for addressing weight loss and health conditions that occur as a result of morbid or severe obesity. Lifestyle changes, dietary modifications, and regular exercise are required for optimal and lasting surgical weight loss. Perioperative care of bariatric patients requires the use of interventions that differ from those used for nonobese patients, including bariatric-specific equipment, intraoperative monitoring of blood glucose, and postoperative monitoring for respiratory compromise. This articles outlines the risks and typical outcomes associated with three common bariatric procedures-laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass-to help perioperative nurses and other health care providers successfully advise patients and monitor their care for optimal outcomes. PMID:26227518

  10. Horizontal strabismus surgical outcomes in a teaching hospital.

    PubMed

    Idrees, Z; Dooley, I; Fahy, G

    2014-06-01

    Strabismus may result in impaired stereopsis, diplopia, undesirable appearance, amblyopia and negative psychological impact. This study provides epidemiological and surgical outcome information about patients attending University College Hospital Galway requiring strabismus surgery. We report a retrospective analysis of 75 consecutive patients, who underwent horizontal strabismus surgery. Sixty-one (81.3%) patients had clinically significant refractive errors, hyperopia being the most common. Thirty-four (45.3%) patients had amblyopia and nine (12%) required further treatment. A cosmetically acceptable result with a post-operative ocular deviation within 25 prism dioptres of straight (grade 2) was achieved in 70/75 (93.3%) of patients. The overall mean change in ocular deviation per mm of muscle operated was 3.25 prism dioptre/mm. The outcomes of strabismus surgery in an Irish hospital compare very favourably with other jurisdictions. This data will help plan service delivery. PMID:24988834

  11. Arthroscopic Surgical Techniques for the Management of Proximal Biceps Injuries.

    PubMed

    Werner, Brian C; Holzgrefe, Russell E; Brockmeier, Stephen F

    2016-01-01

    Current arthroscopic surgical techniques for the management of proximal biceps tendon disorders encompass 3 commonly advocated procedures: proximal biceps anchor reattachment (superior labrum anterior to posterior or SLAP repair), biceps tenotomy, and arthroscopic biceps tenodesis. The indications for each procedure vary based on injury pattern, symptomatic presentation, concomitant pathologic abnormality, and most notably, patient factors, such as age, functional demand, and specific sport or activity participation. Outcomes after SLAP repair are generally favorable, although recent studies have found biceps tenodesis to be the preferred treatment for certain patient populations. PMID:26614472

  12. Monocular Elevation Deficiency: A Case Series of Surgical Outcome

    PubMed Central

    Talebnejad, Mohammad Reza; Roustaei, Gholam Abbas; Khalili, Mohammad Reza

    2014-01-01

    Background: Inferior rectus recession, Knapp procedure, partial tendon transposition, and combined procedure are different surgical procedures in the management of monocular elevation deficiency (MED). Only a few studies have been published on the management of this problem. In this study, we report our experience with patients with MED focusing on the indications and types of surgery in the south of Iran. Methods: In this case series, a computerized database review on 4773 patients with strabismus was performed and 18 patients diagnosed as having MED who had undergone strabismus surgery were enrolled. Results: Of the 18 patients, 13 had only hypotropia and 5 had horizontal deviation as well. Preoperative vertical deviation was between 15 and 60 prism diopter (mean±SD=25.8±10.7 PD). Fourteen patients had positive forced duction test on elevation. Seventeen patients had ptosis twelve of them had true ptosis and the remaining 5 had pseudoptosis). The mean postoperative follow-up was 24.4 months. Four patients underwent Knapp procedure, 12 patients underwent inferior rectus recession, and for 2 patients a combined procedure was performed. The mean postoperative hypotropia was 6.1±7.9 PD. Twelve out of the 18 patients were corrected to within five PD of orthophoria and no one was found with overcorrection. Conclusion: Although MED is etiologically multifactorial, satisfactory surgical results can be achieved by judicious selection of the surgical technique based on the results of the forced duction test. PMID:24644378

  13. Evaluation of Factors Affecting the Surgical Outcome in Tympanoplasty

    PubMed Central

    Naderpour, Masoud; Jabbari Moghadam, Yalda; Ghanbarpour, Ensieh; Shahidi, Nikzad

    2016-01-01

    Introduction: Tympanoplasty is a standard procedure to repair tympanic membrane perforation. The aim of this study is to evaluate the results of tympanoplasty (hearing improvement and tympanic membrane closure rate) in patients suffering from chronic perforation of the tympanic membrane by considering the prognostic factors. Materials and Methods: In a prospective study, based on the results of tympanoplasty with temporal graft fascia in 60 patients in the ENT department of the Medical Science University of Tabriz, we evaluated prognostic factors, such as age, sex, smoking, size, and site of perforation, for the outcome of this surgery. Results: The rate of surgical success- integration of the graft- was 93.3%. Improvement of hearing, as demonstrated through audiometry, occurred in 93% of cases. We did not find any factors to be statistically significant to affect surgical outcome. Conclusion: Even by considering the influence of different factors on the results of a tympanoplasty operation, according to the statistical results of this study, there is not a significant difference in the results of the operation, neither in the health of the tympanic membrane after surgery nor in hearing development. PMID:27280095

  14. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.

    PubMed

    Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

    2014-12-01

    The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials. PMID:24390042

  15. Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

    PubMed Central

    Pinheiro, Carlos Passos; Rezek, Daniele; Costa, Eduardo Paiva; de Carvalho, Edvagner Sergio Leite; Moscoso, Freddy Antonio Brito; Taborga, Percy Richard Chavez; Jeronimo, Andreia Dias; Abizaid, Alexandre Antonio Cunha; Ramos, Auristela Isabel de Oliveira

    2016-01-01

    Background Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08). Conclusion Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk. PMID:27305109

  16. Imaging and surgical outcomes of spinal tumors in 18 dogs and one cat.

    PubMed

    Besalti, Omer; Caliskan, Murat; Can, Pinar; Vural, Sevil Atalay; Algin, Oktay; Ahlat, Ozan

    2016-06-30

    Clinical and magnetic resonance imaging (MRI) findings, histological appearances and surgical outcomes of 18 dogs and one cat with spinal tumors are presented. Medical records of the cases admitted for spinal disorders were reviewed, and cases of spinal tumors that were diagnosed by MRI and confirmed by histological examination were included in this study. T1 weighted, T2 weighted and contrast enhanced T1 weighted images were taken and interpreted to evaluate the spinal tumors. The tumors were diagnosed as: meningioma (n = 6), ependymoma (n = 1), nerve sheath tumor (n = 4), metastatic spinal tumor (n = 3), osteosarcoma (n = 2), osteoma (n = 1), rhabdomyosarcoma (n = 1), and nephroblastoma (n = 1). Thirteen cases underwent surgical operation and the remaining six cases were euthanized at the request of the owners. The neurological status of the surgical cases did not deteriorate, except for one dog that showed ependymoma in the early period after the operation. These results indicate the potential for surgical gross total tumor removal of vertebral tumors to provide better quality of life and surgical collection of histological specimens for definitive diagnosis. For effective case management, dedicated MRI examination is important to accurate evaluation of the spinal tumors, and surgical treatment is useful for extradural and intradural-extramedullary spinal tumors. PMID:26645333

  17. Imaging and surgical outcomes of spinal tumors in 18 dogs and one cat

    PubMed Central

    Caliskan, Murat; Can, Pinar; Vural, Sevil Atalay; Algin, Oktay; Ahlat, Ozan

    2016-01-01

    Clinical and magnetic resonance imaging (MRI) findings, histological appearances and surgical outcomes of 18 dogs and one cat with spinal tumors are presented. Medical records of the cases admitted for spinal disorders were reviewed, and cases of spinal tumors that were diagnosed by MRI and confirmed by histological examination were included in this study. T1 weighted, T2 weighted and contrast enhanced T1 weighted images were taken and interpreted to evaluate the spinal tumors. The tumors were diagnosed as: meningioma (n = 6), ependymoma (n = 1), nerve sheath tumor (n = 4), metastatic spinal tumor (n = 3), osteosarcoma (n = 2), osteoma (n = 1), rhabdomyosarcoma (n = 1), and nephroblastoma (n = 1). Thirteen cases underwent surgical operation and the remaining six cases were euthanized at the request of the owners. The neurological status of the surgical cases did not deteriorate, except for one dog that showed ependymoma in the early period after the operation. These results indicate the potential for surgical gross total tumor removal of vertebral tumors to provide better quality of life and surgical collection of histological specimens for definitive diagnosis. For effective case management, dedicated MRI examination is important to accurate evaluation of the spinal tumors, and surgical treatment is useful for extradural and intradural-extramedullary spinal tumors. PMID:26645333

  18. Surgical Management in Primary Congenital Glaucoma: Four Debates

    PubMed Central

    Chang, Ta C.; Cavuoto, Kara M.

    2013-01-01

    Primary congenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment. As the abundance of surgical treatment options continues to expand, the authors will compare and contrast the available options and attempt to provide a consensus on surgical management. PMID:23762530

  19. Surgical management of pancreatic neuroendocrine tumors.

    PubMed

    Kimura, Wataru; Tezuka, Koji; Hirai, Ichiro

    2011-10-01

    This study outlines the surgical management and clinicopathological findings of pancreatic neuroendocrine tumors (P-NETs). There are various surgical options, such as enucleation of the tumor, spleen-preserving distal pancreatectomy, distal pancreatectomy with splenectomy, pancreatoduodenectomy, and duodenum-preserving pancreas head resection. Lymph node dissection is performed for malignant cases. New guidelines and classifications have been proposed and are now being used in clinical practice. However, there are still no clear indications for organ-preserving pancreatic resection or lymph node dissection. Hepatectomy is the first choice for liver metastases of well-differentiated neuroendocrine carcinoma without extrahepatic metastases. On the other hand, cisplatin-based combination therapy is performed as first-line chemotherapy for metastatic poorly differentiated neuroendocrine carcinoma. Other treatment options are radiofrequency ablation, transarterial chemoembolization/embolization, and liver transplantation. Systematic chemotherapy and biotherapy, such as that with somatostatin analogue and interferon-α, are used for recurrence after surgery. The precise surgical techniques for enucleation of the tumor and spleen-preserving distal pancreatectomy are described. PMID:21922354

  20. Lisfranc Injury Imaging and Surgical Management.

    PubMed

    Llopis, Eva; Carrascoso, Javier; Iriarte, Inigo; Serrano, Mariano de Prado; Cerezal, Luis

    2016-04-01

    The Lisfranc joint is composed of the cuneiform bones and the cuboid and metatarsal bases, united by a synovial capsule and ligamentous complex. Familiarity with the anatomy is essential for image planning and for understanding injury patterns. The more important structures are the Lisfranc ligament and the plantar ligaments that can be visualized with MR, although careful attention to technique and orientation of scan planes is required for accuracy. A combination of conventional radiographs, computed tomography, and MR allow precise diagnosis of Lisfranc fractures, fracture dislocation, and subtle Lisfranc injuries to guide clinical management and surgical planning. PMID:27336449

  1. Surgical management of recurrent ovarian cancer.

    PubMed

    Leitao, Mario M; Chi, Dennis S

    2009-04-01

    Surgery is the cornerstone of treatment for patients with advanced ovarian cancer. The majority of patients with advanced ovarian cancer who experience a clinical remission after initial surgery will develop a recurrence. The optimal management for patients with recurrent ovarian cancer remains to be defined. Chemotherapy is frequently used with varying response rates. Repeat surgical cytoreduction appears to offer a survival benefit for select patients with recurrent ovarian cancer and should be considered. Surgery also plays a role in the palliation of certain patients. Continued investigations, especially randomized trials, are needed to further define the optimal treatment modalities for these patients. PMID:19332245

  2. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients

    PubMed Central

    2011-01-01

    Background The elderly population has increased in many countries. Indications for cancer treatment in elderly patients have expanded, because surgical techniques and medical management have improved remarkably. Pancreaticoduodenectomy (PD) requires high-quality techniques and perioperative management methods. If it is possible for elderly patients to withstand an aggressive surgery, age should not be considered a contraindication for PD. Appropriate preoperative evaluation of elderly patients will lead to their safer management. The purpose of the present study was to evaluate the safety of PD in patients older than 75 years and to show the influence of advanced age on the morbidity and mortality associated with this operation. Patients and methods Subjects were 98 patients who underwent PD during the time period from April 2005 to April 2011. During this study, 31 patients were 75 years of age or older (group A), and the other 67 patients were less than 75 years old (group B). Preoperative demographic and clinical data, surgical procedure, pathologic diagnosis, postoperative course and complication details were collected prospectively and they were analyzed in two group. Results There was no statistical difference between patient groups in terms of gender, comorbidity, preoperative drainage, diagnosis, or laboratory data. Preoperative albumin values were lower in group A (P = 0.04). The mean surgical time in group A was 408.1 ± 73.47 min. Blood loss and blood transfusion were not significantly different between both groups. There was no statistical differences in mortality rate (P = 0.14), morbidity rate (P = 0.43), and mean length of hospital stay (P = 0.22) between both groups. Long-term survival was also no statistically significant difference between the two groups using the log-rank test (P = 0.10). Conclusion It cannot be ignored that the elderly population is getting larger. We must investigate the management of elderly patients after PD and prepare

  3. Outcome of Surgical Treatment of 200 Children With Cushing's Disease

    PubMed Central

    Lonser, Russell R.; Wind, Joshua J.; Nieman, Lynnette K.; Weil, Robert J.; DeVroom, Hetty L.

    2013-01-01

    Context: Factors influencing the outcome of surgical treatment of pediatric Cushing's disease (CD) have not been fully established. Objective: The aim of this study was to examine features influencing the outcome of surgery for pediatric CD. Design: In this prospective observational study, the clinical, imaging, endocrinological, and operative outcomes were analyzed in consecutive patients treated at the National Institutes of Health (NIH) from 1982 through 2010. Setting: The study was conducted in a tertiary referral center. Results: Two hundred CD patients (106 females, 94 males) were included. Mean age at symptom development was 10.6 ± 3.6 years (range, 4.0 to 19.0 y). Mean age at NIH operation was 13.7 ± 3.7 years. Twenty-seven patients (13%) had prior surgery at another institution. Magnetic resonance imaging identified adenomas in 97 patients (50%). When positive, magnetic resonance imaging accurately defined a discrete adenoma in 96 of the 97 patients (99%), which was more accurate than the use of ACTH ratios during inferior petrosal sinus sampling to determine adenoma lateralization (accurate in 72% of patients without prior surgery). A total of 195 of the 200 patients (98%) achieved remission after surgery (189 [97%] were hypocortisolemic; 6 [3%] were eucortisolemic postoperatively). Factors associated with initial remission (P < .05) included identification of an adenoma at surgery, immunohistochemical ACTH-producing adenoma, and noninvasive ACTH adenoma. Younger age, smaller adenoma, and absence of cavernous sinus wall or other dural invasion were associated with long-term remission (P < .05). A minimum morning serum cortisol of less than 1 μg/dl after surgery had a positive predictive value for lasting remission of 96%. Conclusions: With rare disorders, such as pediatric CD, enhanced outcomes are obtained by evaluation and treatment at centers with substantial experience. Resection of pituitary adenomas in pediatric CD in that setting can be safe

  4. Surgical management of postpartum haemorrhage: survey of French obstetricians

    PubMed Central

    Bouet, Pierre-Emmanuel; Brun, Stéphanie; Madar, Hugo; Schinkel, Elsa; Merlot, Benjamin; Sentilhes, Loïc

    2016-01-01

    The aim of our study was to assess the theoretical and practical knowledge of French obstetricians about the surgical management of postpartum haemorrhage (PPH). Our study is a national anonymous self-administered survey. A total of 363 obstetricians responded to this questionnaire between December 2013 and April 2014. Questionnaire sent through email to all French obstetricians who are members of either of two federations of hospital-based obstetricians. Answers were collected until the end of June 2014. The main outcome measure was obstetricians’ level of mastery of each surgical technique. The results were analysed descriptively (proportions). Only the 286 questionnaires fully completed were analysed; the complete response rate was 23% (286/1246). In all, 33% (95/286) of the responding obstetricians reported that they had not mastered sufficiently or even at all the technique for bilateral ligation of the uterine arteries, 37% (105/286) for uterine compression suture, 62% (178/286) for ligation of the internal iliac arteries, and 47% (134/286) for emergency peripartum hysterectomy. In all, 18% (52/286) of respondents stated that they had not mastered any of these techniques. Our study shows that a worrisome number of French obstetricians reported insufficient mastery of the surgical techniques for PPH management. PMID:27460158

  5. Predisposing factors and surgical outcome of complicated liver hydatid cysts

    PubMed Central

    Akcan, Alper; Sozuer, Erdogan; Akyildiz, Hizir; Ozturk, Ahmet; Atalay, Altay; Yilmaz, Zeki

    2010-01-01

    AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease. METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics. RESULTS: When the predisposing factors for complications were evaluated, younger age, superficial position, and larger cyst dimensions (P < 0.05; range, 0.001-0.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.001-0.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of post-operative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no significant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree. PMID:20572308

  6. Connectome Reorganization Associated With Surgical Outcome in Temporal Lobe Epilepsy

    PubMed Central

    Ji, Gong-Jun; Zhang, Zhiqiang; Xu, Qiang; Wei, Wei; Wang, Jue; Wang, Zhengge; Yang, Fang; Sun, Kangjian; Jiao, Qing; Liao, Wei; Lu, Guangming

    2015-01-01

    Abstract To identify the distinct pattern of anatomical network reorganization in surgically refractory mesial temporal lobe epilepsy (MTLE) patients using a longitudinal design. We collected longitudinal diffusion-weighted images of 19 MTLE patients before and after anterior temporal lobectomy. Patients were classified as seizure-free (SF) or nonseizure-free (NSF) at least 1 year after surgery. We constructed whole-brain anatomical networks derived from white matter tractography and evaluated network connectivity measures by graph theoretical analysis. The reorganization trajectories of network measures in SF and NSF patients were investigated by two-way mixed analysis of variance, with factors “group” (SF vs NSF) and “treatment” (presurgery vs postsurgery). Widespread brain structures showed opposite reorganization trajectories in FS and NSF groups (interaction effect). Most of them showed group difference before surgery and then converge after surgery, suggesting that surgery remodeled these structures into a similar status. Conversly, contralateral amygdala-planum-temporale and thalamic-parietal tracts showed higher connectivity strength in NSF than in SF patients after surgery, indicating maladaptive neuroplastic responses to surgery in NSF patients. Our findings suggest that surgical outcomes are associated not only with the preoperative pattern of anatomical connectivity, but also with connectome reconfiguration following surgery. The reorganization of contralateral temporal lobe and corticothalamic tracts may be particularly important for seizure control in MTLE. PMID:26448031

  7. Clinical outcome of surgical treatment for periorbital basal cell carcinoma.

    PubMed

    Kakudo, Natsuko; Ogawa, Yutaka; Suzuki, Kenji; Kushida, Satoshi; Kusumoto, Kenji

    2009-11-01

    Basal cell carcinoma (BCC) has a predilection for the periorbital region, which is a special, prominent, cosmetic, functional area to protect the eyeball. For squamous cell carcinoma and melanoma, extensive resection with reconstruction is performed. In contrast, for BCC, resection is often confined to a small to medium-sized area, necessitating higher-quality reconstructive surgery. We analyze the surgical outcomes of treatment for periorbital BCC, and evaluate reconstruction method after resection. Forty-nine patients with periorbital BCC had surgery in our hospital over 20 years. Age, gender of the patients, and size, localization, and histology of the tumor, and surgical procedures, and their early and late complications were analyzed retrospectively. BCC was most frequently occurred in the lower lid (55%), followed by inner canthus (19%), upper lid (17%), and outer canthus (9%). The histologic classifications were solid (80%), morphea (7%), mix (7%), superficial (2%), keratotic (2%), and adenoid (2%). Recurrence of the tumor was observed in 2 advanced cases in patients treated with resection of the tumor including surrounding tissue 5 mm from the margin. A rotation advancement cheek flap procedure was most frequently applied. Horizontal shift of the skin was most effective to prevent postoperative lagophthalmos. BCC occurred most frequently in the lower lid within the periorbital area. Rotation advancement of cheek flap with horizontal shift of the skin is most effective procedure in both appearance and function of the eyelid. PMID:19801921

  8. Clinical attributes and surgical outcomes of angiocentric gliomas.

    PubMed

    Ampie, Leonel; Choy, Winward; DiDomenico, Joseph D; Lamano, Jonathan B; Williams, Christopher Kazu; Kesavabhotla, Kartik; Mao, Qinwen; Bloch, Orin

    2016-06-01

    Angiocentric gliomas (AG) are exceedingly rare low-grade neoplasms which often present in the form of intractable epilepsy within younger patients. The current study extensively reviews all reported cases which were pathologically verified as AG in the literature to analyze clinical attributes and surgical outcomes of this neoplasm. There were 88 patients with AG reported in the literature consisting mostly of pediatric cases. The sex distribution consisted of 45 males and 36 females with the remaining seven cases not documenting sex. The average age of initial diagnosis was 16years with almost half of all diagnosed patients being within the first decade of life. In cases where extent of resection was reported, gross total resection (GTR) was achieved in 54 patients, subtotal resection (STR) in 16, and biopsy only in three. Post-operative complications were transient and only occurred in three patients with no reports of death following surgery. Only five cases reported tumor recurrence on follow-up. Eight patients had seizure recurrence post-operatively and GTR offered improved rates of seizure control when compared to STR (p=0.0005). Nearly half of the cases of AG are diagnosed within the first decade of life and they usually manifest with intractable seizures. GTR appears to offer better seizure control in the post-operative period. Surgical resection is the mainstay therapy for AG as post-operative complications and tumor recurrence remain uncommon. Since the number of reported cases is limited, future studies with longer follow-up periods will help elaborate more long-term outcomes. PMID:26778052

  9. Facial Nerve Paralysis in Patients With Chronic Ear Infections: Surgical Outcomes and Radiologic Analysis

    PubMed Central

    Choi, Jin Woong

    2015-01-01

    Objectives The purpose of this study was to investigate the clinical features, radiologic findings, and treatment outcomes in patients of facial nerve paralysis with chronic ear infections. And we also aimed to evaluate for radiologic sensitivities on facial canal, labyrinth and cranial fossa dehiscences in middle ear cholesteatomas. Methods A total of 13 patients were enrolled in this study. Medical records were retrospectively reviewed for clinical features, radiologic findings, surgical findings, and recovery course. In addition, retrospective review of temporal bone computed tomography (CT) and operative records in 254 middle ear cholesteatoma patients were also performed. Results Of the 13 patients, eight had cholesteatomas in the middle ear, while two patients exhibited external auditory canal cholesteatomas. Chronic suppurative otitis media, petrous apex cholesteatoma and tuberculous otitis media were also observed in some patients. The prevalence of facial paralysis in middle ear cholesteatoma patients was 3.5%. The most common involved site of the facial nerve was the tympanic segment. Labyrinthine fistulas and destruction of cranial bases were more frequently observed in facial paralysis patients than nonfacial paralysis patients. The radiologic sensitivity for facial canal dehiscence was 91%. The surgical outcomes for facial paralysis were relatively satisfactory in all patients except in two patients who had petrous apex cholesteatoma and requiring conservative management. Conclusion Facial paralyses associated with chronic ear infections were observed in more advanced lesions and the surgical outcomes for facial paralysis were relatively satisfactory. Facial canal dehiscences can be anticipated preoperatively with high resolution CTs. PMID:26330915

  10. Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

    PubMed

    Pozzoli, Alberto; Elisabetta, Lapenna; Vicentini, Luca; Alfieri, Ottavio; De Bonis, Michele

    2016-09-01

    The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation. PMID:27329290

  11. The embryology and surgical management of gastroschisis.

    PubMed

    Thomas, D F; Atwell, J D

    1976-11-01

    Thirteen cases of gastroschisis are presented and a reduction in the operative mortality to 15 per cent is recorded. The aetiology of the condition is discussed and the opinion expressed that it represents the result of an intra-uterine rupture of an incarcerated "hernia into the cord" rather than any specific failure of development of the abdominal wall musculature. Early skin closure and the creation of a ventral hernia remain the surgical treatment of choice, but it is recognized that the use of a prosthetic sac may occasionally be necessary. Infection is not the most important single factor influencing mortality, and the prolonged administration of prophylactic antibiotics is justified on this basis. Skilled management of the protracted ileus is essential. In view of the low incidence of serious coexistent malformations the children who survive the initial operation can be offered the prospect of a life of normal duration and quality. PMID:137025

  12. The surgical management of the arthritic hand.

    PubMed Central

    Harrison, S. H.

    1979-01-01

    The surgical management of the arthritic hand is very largely concerned with rheumatoid arthritis and Still's disease and less frequently with psoriatic and degenerative arthritis. In the rheumatoid hand the surgeon may be called upon to intervene at any point in the chain reaction leading to total deformity, performing synovectomies of joints or tendons to relieve pain or prevent further deformity, repairing ruptured tendons, restoring the mechanism of injured joints, and correcting deformities when they have been allowed to occur. The great variety of operations that may be necessary to achieve these ends, with varying degrees of success, are discussed with reference to a personal series of 970 cases and 2002 operations. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 7 FIG. 6 FIG. 8 PMID:420491

  13. Innovations in surgical management of nonobstructive azoospermia.

    PubMed

    Ran, Renzhong; Kohn, Taylor Poteet; Ramasamy, Ranjith

    2016-01-01

    Testicular sperm extraction (TESE) technique and intra-cytoplasmic sperm injection are breakthrough fertility treatments for men with nonobstructive azoospermia (NOA). Newer advances such as the microdissection-TESE (micro-TESE) technique have continued to build upon past success by improving sperm retrieval and minimizing the postoperative complications compared to TESE. However, even with micro-TESE, sperm retrieval success has ranged from 40% to 60% due to the technique's dependence on surgeon and embryologist experience. While postoperative complications are minimal relative to the traditional TESE technique, testicular tissue must still be extracted without the knowledge of whether sperm are present in biopsies. In this review, we discuss the innovations in the surgical management of men with NOA and describe the novel experimental approaches that can improve sperm retrieval success. PMID:26941489

  14. Innovations in surgical management of nonobstructive azoospermia

    PubMed Central

    Ran, Renzhong; Kohn, Taylor Poteet; Ramasamy, Ranjith

    2016-01-01

    Testicular sperm extraction (TESE) technique and intra-cytoplasmic sperm injection are breakthrough fertility treatments for men with nonobstructive azoospermia (NOA). Newer advances such as the microdissection-TESE (micro-TESE) technique have continued to build upon past success by improving sperm retrieval and minimizing the postoperative complications compared to TESE. However, even with micro-TESE, sperm retrieval success has ranged from 40% to 60% due to the technique's dependence on surgeon and embryologist experience. While postoperative complications are minimal relative to the traditional TESE technique, testicular tissue must still be extracted without the knowledge of whether sperm are present in biopsies. In this review, we discuss the innovations in the surgical management of men with NOA and describe the novel experimental approaches that can improve sperm retrieval success. PMID:26941489

  15. Surgical Management of Post-Traumatic Iris Cyst

    PubMed Central

    Philip, Swetha Sara; John, Deepa Rebecca; Ninan, Fini; John, Sheeja Susan

    2015-01-01

    Purpose : Epithelial cysts of the iris may be primary or secondary. The management of secondary, posttraumatic iris cysts is often challenging. The purpose of this work is to report the successful surgical management of a post-traumatic iris cyst. Case Report: A 38 year-old man presented with an iris cyst associated with epithelial downgrowth and total cataract, six years after sustaining a penetrating injury to his right eye. The iris cyst was excised in toto with the epithelial downgrowth, and the procedure was combined with cataract extraction and intra ocular lens implantation. The patient had good post-operative visual recovery with minimal inflammatory reaction. Conclusion: Post-traumatic cysts of the iris can be associated with significant ocular morbidity. Many different modalities of treatment, with varying degrees of success, have been described for the treatment of iris cysts. Excision of the iris cyst in toto is a good surgical management option, which can result in an excellent functional outcome with minimal inflammatory complications. PMID:26862359

  16. Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management.

    PubMed

    Zhang, Han; Yang, Tian; Wu, Mengchao; Shen, Feng

    2016-09-01

    Intrahepatic cholangiocarcinoma (ICC), the least common form of cholangiocarcinomas, is a rare hepatobiliary malignancy that arises from the epithelial cells of the intrahepatic bile ducts. The incidence of ICC has been rising in the global scale over the last twenty years, which may reflect both a true increase and the trend of earlier detection of the disease. Other than some well recognized causative risk factors, the association between viral and metabolic factors and ICC pathogenesis has been increasingly identified recently. Surgical resection is currently the only feasible modality with a curative ability, but the resectability and curability remain low. The high invasiveness of ICC predisposes the tumors to multifocality, node metastasis and vascular invasions, leading to poor long-term survival after resection. The role of liver transplantation is controversial, while locoregional treatments and systematic therapies may provide survival benefits, especially in patients with unresectable and advanced tumors. The present review discussed the epidemiology, risk factors, surgical and multimodal management of ICCs, which mainly focused on the outcomes and factors associated with surgical treatment. PMID:26409434

  17. Surgical management of the septic complications of diverticular disease.

    PubMed Central

    Khan, A. L.; Ah-See, A. K.; Crofts, T. J.; Heys, S. D.; Eremin, O.

    1995-01-01

    This retrospective study has reviewed the surgical management of the septic complications of diverticular disease involving the left colon in 77 patients who presented between 1980 and 1992. Over this period, Hartmann's resection continued to be the predominant surgical procedure. The overall mortality and morbidity rates in the study period were 10% and 31%, respectively. However, a marked improvement in survival was recorded in the latter half of the study (17% vs 6%). The mortality from Hartmann's resection was also reduced substantially in the second half of the study (24% vs 7.5%). These improvements occurred despite having a higher number of poor-risk patients (APACHE II score) with more severe pathology (generalised peritonitis, 35% vs 50%; faecal peritonitis, 9% vs 25%) in the latter half. There was a significantly worse survival in patients who were over 70 years of age (P < 0.03), those who had a severe concomitant medical illness (P < 0.02), those who had a generalised peritonitis (P < 0.02), and in those patients who had an APACHE II score of over 11 (P < 0.05) (Fisher's exact test). There was no difference in outcome (morbidity, mortality) between the various grades of surgeon involved in performing the emergency surgical procedures. PMID:7717637

  18. Outcome of surgical treatment of intestinal perforation in typhoid fever

    PubMed Central

    Sümer, Aziz; Kemik, Özgür; Dülger, Ahmet Cumhur; Olmez, Aydemir; Hasirci, Ismail; Kişli, Erol; Bayrak, Vedat; Bulut, Gulay; Kotan, Çetin

    2010-01-01

    AIM: To represent our clinical experience in the treatment of intestinal perforation arising from typhoid fever. METHODS: The records of 22 surgically-treated patients with typhoid intestinal perforation were evaluated retrospectively. RESULTS: There were 18 males and 4 females, mean age 37 years (range, 8-64 years). Presenting symptoms were fever, abdominal pain, diarrhea or constipation. Sixteen cases were subjected to segmental resection and end-to-end anastomosis, while 3 cases received 2-layered primary repair following debridement, one case with multiple perforations received 2-layered primary repair and end ileostomy, one case received segmental resection and end-to-end anastomosis followed by an end ileostomy, and one case received segmental resection and end ileostomy with mucous fistula operation. Postoperative morbidity was seen in 5 cases and mortality was found in one case. CONCLUSION: Intestinal perforation resulting from Salmonella typhi is an important health problem in Eastern and Southeastern Turkey. In management of this illness, early and appropriate surgical intervention is vital. PMID:20806433

  19. Surgical treatment achieves better outcome in severe traumatic pericallosal aneurysm: case report and literature review

    PubMed Central

    Sui, Mingxing; Mei, Qiyong; Sun, Kehua

    2015-01-01

    Traumatic pericallosal aneurysm (TPA) is typically seldom yet potentially lethal. Because of its rarity, also complicated by the unpredictable delayed-onset, TPA is more difficult to be diagnosed promptly. Due to the sporadic reports and diverse opinions on the priority of surgical treatment, a consensus about effective management of TPA has not been reached. Here we report a 55 year-old male patient with TPA, who received an emergent craniotomy to clip the pseudoaneurysm and remove the hematoma under intense intracranial pressure (ICP) monitoring. A satisfactory clinical outcome was achieved at a 3-month follow-up. Thereafter, a review was conducted to evaluate the outcomes of different managing modalities. PMID:25932088

  20. Effect of surgical timing and outcomes for appendicitis severity

    PubMed Central

    Kim, Maru; Kim, Sung Jeep

    2016-01-01

    Purpose This study was aimed to evaluate the effect of time of surgery for acute appendicitis on surgical outcomes to optimize the timing of appendectomies. Methods Medical records of patients who underwent an appendectomy were reviewed to obtain data on time of symptom onset, time of hospital presentation, and start times of surgery. Surgical findings were used to define appendicitis as either uncomplicated or complicated. The uncomplicated group included patients with simple, focal, or suppurative appendicitis, and the complicated group included patients with gangrenous, perforated appendicitis or periappendiceal abscess formation. The 2 groups were analyzed by age, sex, and time. Results A total of 192 patients were analyzed. The mean time from symptom onset to start of operation showed a significant difference between both groups (1,652.9 minutes vs. 3,383.8 minutes, P < 0.001). The mean time from hospital visit to start of operation showed no difference between both groups (398.7 minutes vs. 402.0 minutes, P = 0.895). Operating within 24 hours of symptom onset had a relative risk of 1.738 (95% confidence interval, 1.319–2.425) for complications. Operating more than 36 hours after symptom onset was associated with an increased risk of postoperative ileus and a longer hospital stay. Conclusion Complicated appendicitis is associated with a delay in surgery from symptom onset rather than a delay at hospital arrival. Surgeons should take into account the time from symptom onset when deciding on the timing of appendectomy. We recommend that appendectomy be performed within 36 hours from symptom onset. PMID:27478814

  1. Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry

    PubMed Central

    Allvin, Renée; Rawal, Narinder; Johanzon, Eva; Bäckström, Ragnar

    2016-01-01

    Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient's perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (P = 0.012). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean ≥ 5 in both groups). Pain interference with mobilization was reported by 87–93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given. PMID:27127649

  2. Surgical management of pelvic Ewing’s sarcoma

    PubMed Central

    Natarajan, Mayil Vahanan; Sameer, M Mohamed; Bose, Jagdish Chandra; Dheep, Kunal

    2010-01-01

    Background: Despite advances in adjuvant therapy, Ewing’s sarcoma of the pelvis remains an anatomic site with a poor prognosis due to its relative inaccessibility, complex anatomy, and limited reconstructive options available. This study evaluates the role of surgery in the management of patients with pelvic Ewing’s sarcoma who also have received conventional radiation therapy and chemotherapy. Materials and Methods: From July 1990 to July 2006, we received 10 patients with Ewing’s sarcoma of pelvis at our center. Nine patients were in stage II B and one in Stage III at the time of presentation to us. All patients underwent surgical resection after preoperative chemotherapy with or without radiotherapy, which was given at the discretion of the referral center. Reconstruction was attempted using plate osteosynthesis in four patients, SS wires and screws in three patients, free fibular strut graft in one patient, and none was done in two patients. Results: Functional outcome assessed by Enneking’s criteria revealed excellent outcome in two patients, good outcome in five patients, and poor outcome in two patients. At a mean followup of 10.3 years, seven patients remained free from the disease, and three patients died. The 5- and 10-year cumulative survival (Kaplan Meier method) was 63% and 34%, respectively. Conclusion: This study demonstrates that surgery plus chemotherapy and radiation therapy is helpful for treating patients with pelvic Ewing’s sarcoma, particularly in achieving local control. PMID:20924480

  3. [Conservative and surgical management of chronic Rhinosinustitis].

    PubMed

    Friedrich, Hergen; Negoias, Simona; Caversaccio, Marco Domenico

    2016-01-01

    Chronic rhinosinusitis is a common complex medical condition associated with high therapy costs and quality of life impairment. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 delineates the current standard of management of the patient with chronic rhinosinusitis for both defined disease forms: with and without polyps. Medical history and endoscopic or CT findings are needed for the correct diagnosis. Therapy of chronic rhinosinusitis aims at achieving a local disease control and reducing patients' symptoms. The center point of conservative therapy of both forms is the topical application of steroids together with nasal saline irrigations. In case of persistence of symptoms or in severe chronic rhinosinusitis with polyps, different local application methods of steroids or short systemic steroid cures should be considered. In case of insufficient disease control with conservative treatment, functional endoscopic sinus surgery is the accepted as “gold standard”. Purpose of the surgical management is opening of the sinus ostia in order to improve sinus ventilation and mucociliary clearance as well as to facilitate a wide distribution of topical drugs. Due to technical advances, endoscopic sinus has been reported to be a safe and effective procedure. PMID:27132639

  4. Improving Outcomes with Surgical Resection and Other Ablative Therapies in HCC

    PubMed Central

    Deshpande, Rahul; O'Reilly, Derek; Sherlock, David

    2011-01-01

    With rising incidence and emergence of effective treatment options, the management of hepatocellular carcinoma (HCC) is a complex multidisciplinary process. There is still little consensus and uniformity about clinicopathological staging systems. Resection and liver transplantation have been the cornerstone of curative surgical treatments with recent emergence of ablative techniques. Improvements in diagnostics, surgical techniques, and postoperative care have lead to dramatically improved results over the years. The most appropriate treatment plan has to be individualised and depends on a variety of patient and tumour-related factors. Very small HCCs discovered on surveillance have the best outcomes. Patients with advanced cirrhosis and tumours within Milan criteria should be offered transplantation. Resection is best for small solitary tumours with preserved liver function. Ablative techniques are suitable for low volume tumours in patients unfit for either resection or transplantation. The role of downstaging and bridging therapy is not clearly established. PMID:21994867

  5. Surgical management of a completely avulsed adductor longus muscle in a professional equestrian rider.

    PubMed

    Quah, Conal; Cottam, Andrew; Hutchinson, James

    2014-01-01

    Avulsion injuries of the adductor longus muscle tendon are rare and a challenge to manage especially in athletes. There has been little published literature on the outcome of conservative and operative treatment for these injuries. We report the first case of an acute adductor longus avulsion injury which was surgically repaired in a professional equestrian rider. Return to full preinjury function was achieved at 3 months with surgical repair using 3 suture anchors. PMID:24711943

  6. [A rare case of surgical management of a patient with thoracic aortic aneurysm].

    PubMed

    Kospanov, N A; Mierbekov, E M; Eshmuratov, T Sh; Kodasbaev, A T; Kirgizbaev, S Zh

    2012-01-01

    Described in the article is a clinical case of successful surgical management of a male patient diagnosed with a syphilitic-origin aneurysm of the thoracic aorta isthmus, complicated by an aortopulmonary fistula. Also presented herein are the clinical pattern, findings of examination, and treatment policy. This is followed by a detailed description of both the course of the surgical intervention and outcomes obtained. PMID:22929686

  7. Surgical and Obstetric Outcomes in Adults with Sickle Cell Disease

    PubMed Central

    Adam, Soheir; Jonassaint, Jude; Kruger, Hillary; Kail, Melanie; Orringer, Eugene P.; Eckman, James R.; Ashley-Koch, Allison; Telen, Marilyn J.; De Castro, Laura M.

    2013-01-01

    BACKGROUND Sickle cell disease patients are more likely than the general population to undergo surgery and usually do so at a younger age. Female sickle cell disease patients also have special gynecological and obstetric issues related to their disease. METHODS We collected data through standardized clinical report forms, patient interviews, and medical records from 509 adult sickle cell disease patients. Logistic regression was used to estimate the association between multiple variables and each of the surgery types. We also determined the prevalence and outcomes of pregnancy in 284 women with sickle cell disease in this population. RESULTS Almost 50% of patients aged 18–27 years had had a cholecystectomy. Mean corpuscular hemoglobin, total bilirubin, and lactate dehydrogenase were significantly higher in the postcholecystectomy group; 9.5% of 504 individuals had undergone splenectomy. Hematocrit, body mass index, and red blood cell count were significantly higher in the postsplenectomy group. Hip replacement had been performed in 9.2% of individuals, with the prevalence increasing as early as the fourth decade and continuing to increase through the sixth decade of life. A history of pregnancy was present in 190 women (67%). Of 410 pregnancies, only 53.9% resulted in live births, 16.6% were voluntarily terminated, and 29.5% were complicated by miscarriage, still birth, or ectopic implantation. CONCLUSIONS Sickle cell disease continues to have a strong effect on the mean age for common surgeries and impacts pregnancy outcomes. We conclude that this population has a unique surgical and obstetric history that should be further studied to provide insight into potentially more effective preventive approaches to end-organ damage. PMID:18823864

  8. Non-surgical treatments for the management of early osteoarthritis.

    PubMed

    Filardo, Giuseppe; Kon, Elizaveta; Longo, Umile Giuseppe; Madry, Henning; Marchettini, Paolo; Marmotti, Antonio; Van Assche, Dieter; Zanon, Giacomo; Peretti, Giuseppe M

    2016-06-01

    Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages. PMID

  9. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

    PubMed Central

    Nuño-Guzmán, Carlos M.; García-Carrasco, Daniel; Haro, Miguel; Arróniz-Jáuregui, José; Corona, Jorge L.; Salcido, Macario

    2014-01-01

    Zenker's diverticulum (ZD), also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2–6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up. PMID:25759630

  10. Role of adrenal imaging in surgical management

    SciTech Connect

    Lamki, L.M.; Haynie, T.P. )

    1990-03-01

    Adrenal imaging using radiopharmaceuticals is a functional test that can contribute significantly to surgical management and follow-up of patients with either benign or malignant conditions of the adrenal cortex and medulla. Imaging of the cortex is achieved by iodine-131-labeled iodomethyl nor-cholesterol (NP-59), while adrenal medulla imaging can be successfully accomplished by 131I-metaiodobenzylguanidine (MIBG), which localizes in the adrenergic nerve terminal with norepinephrine. Both tests carry high sensitivity and specificity for functional tumors and hyperplasia, and often better than CT scanning. This article reviews the current status and clinical utility of nuclear imaging of the adrenal cortex in congenital hyperplasia, low renin hypertension and aldosteronism, and Cushing's syndrome. Adrenal medulla imaging is reviewed in light of our experience at the University of Texas M.D. Anderson Cancer Center in pheochromocytoma, neuroblastoma, and other neuroectodermal tumors. Investigation of {sup 131}I-MIBG therapy of metastatic tumors of neuroectodermal origin potentially offers a means of at least controlling symptoms of hormonal secretion in these patients. 40 references.

  11. Defining new directions for more effective management of surgical pain in the United States: highlights of the inaugural Surgical Pain Congress™.

    PubMed

    Joshi, Girish P; Beck, David E; Emerson, Roger Hill; Halaszynski, Thomas M; Jahr, Jonathan S; Lipman, Arthur G; Nihira, Mikio A; Sheth, Ketan R; Simpson, Melanie H; Sinatra, Raymond S

    2014-03-01

    Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes. To comprehensively address this need, the multidisciplinary Surgical Pain Congress™ has been established. The inaugural meeting of this Congress (March 8 to 10, 2013, Celebration, Florida) evaluated the current surgical pain management paradigm and identified key components of best practices. PMID:24666860

  12. Surgical management of Mason type III radial head fractures

    PubMed Central

    Miller, George; Humadi, Ali; Unni, Raghavan; Hau, Raphael

    2013-01-01

    The evidence for optimal management of Mason type III fracture of radial head is unclear hence a systematic review of the published literature was performed in April 2012. This review includes 5 prospective studies (including 2 randomized trials), 4 retrospective studies and 9 case series. No study can be interpreted as level 1 evidence. Level 2 and 3 evidence provides some insight into the success of each modality through subjective and objective measurements of function and complication rates. Radial head replacement, open reduction internal fixation (ORIF) and radial head resection all provide satisfactory outcomes for patients in most cases. One treatment modality cannot be recommended over any other due to the small number of clinical trials and cases included in each study. Further randomized control trials are needed to evaluate the full benefits and shortcomings of each of the different surgical treatment modalities. PMID:23960274

  13. Surgical management of osteoradionecrosis of the temporal bone

    SciTech Connect

    Kveton, J.F.

    1988-03-01

    The surgical management of osteoradionecrosis of the temporal bone has met with limited success because of the difficulty in accurate assessment of the viability of nonnecrotic bone intraoperatively. Failure to resect all nonviable bone results in recurrence of a necrotic focus. With the use of hyperbaric oxygen therapy to stabilize marginal bone and oral tetracycline to label viable bone preoperatively, removal of all nonviable bone can be accomplished. Postoperatively, a second course of hyperbaric therapy enhances wound healing, thus assuring a successful outcome. This article details a successful systematic approach that was developed to resect a necrotic focus in the temporal bone of a 10-year-old boy who had undergone a full course of radiotherapy for treatment of a rhabdomyosarcoma.

  14. A 5-year study of the outcome of surgically treated depressed skull fractures.

    PubMed Central

    Al-Haddad, Syed A.; Kirollos, Ramez

    2002-01-01

    BACKGROUND: Many changes and improvement have taken place in the management of head injured patients in the last 20 years. There have been few recent studies analysing the overall outcomes including early complications of depressed skull fractures. The aim of our study was, therefore, to examine the factors influencing the surgical outcome of patients with depressed skull fractures. METHODS: We reviewed case notes of 73 consecutive surgically treated depressed skull fractures during the period from 1 January 1994 to 31 December 1998 admitted to the Walton Centre for Neurology and Neurosurgery, Liverpool. RESULTS: There was a male preponderance of 9:1. Alleged assault was the most common cause of depressed skull fractures followed by road traffic accidents. Postoperative infection rate was 8.2%. More than 80% of patients received prophylactic antibiotics. We failed to show any statistically significant association between the use of antibiotics and reduction of the rate of infection. However, prevalence of infection was significantly associated with brain contusion, low GCS score and dural tear (P < 0.05). Prevalence of early post-traumatic epilepsy was 12.3%. No patients received prophylactic anticonvulsants. There was no significant association between dural tear and prevalence of post-traumatic epilepsy. Mortality rate was 1.4%. CONCLUSIONS: Paediatric populations have better outcome; 7 out of 10 patients in this series progressed to full recovery. Use of prophylactic antibiotics did not reduce the infection rate. Presence of dural tear was not associated with an increase risk of post-traumatic epilepsy. PMID:12092875

  15. Management of surgical instruments with radio frequency identification tags.

    PubMed

    Kusuda, Kaori; Yamashita, Kazuhiko; Ohnishi, Akiko; Tanaka, Kiyohito; Komino, Masaru; Honda, Hiroshi; Tanaka, Shinichi; Okubo, Takashi; Tripette, Julien; Ohta, Yuji

    2016-03-14

    Purpose - To prevent malpractices, medical staff has adopted inventory time-outs and/or checklists. Accurate inventory and maintenance of surgical instruments decreases the risk of operating room miscounting and malfunction. In our previous study, an individual management of surgical instruments was accomplished using Radio Frequency Identification (RFID) tags. The purpose of this paper is to evaluate a new management method of RFID-tagged instruments. Design/methodology/approach - The management system of RFID-tagged surgical instruments was used for 27 months in clinical areas. In total, 13 study participants assembled surgical trays in the central sterile supply department. Findings - While using the management system, trays were assembled 94 times. During this period, no assembly errors occurred. An instrument malfunction had occurred after the 19th, 56th, and 73th uses, no malfunction caused by the RFID tags, and usage history had been recorded. Additionally, the time it took to assemble surgical trays was recorded, and the long-term usability of the management system was evaluated. Originality/value - The system could record the number of uses and the defective history of each surgical instrument. In addition, the history of the frequency of instruments being transferred from one tray to another was recorded. The results suggest that our system can be used to manage instruments safely. Additionally, the management system was acquired of the learning effect and the usability on daily maintenance. This finding suggests that the management system examined here ensures surgical instrument and tray assembly quality. PMID:26959900

  16. Surgical Management of Traumatic Penile Amputation: A Case Report and Review of the World Literature

    PubMed Central

    Raheem, Omer A; Mirheydar, Hossein S; Patel, Nishant D; Patel, Sunil H; Suliman, Ahmed; Buckley, Jill C

    2015-01-01

    Introduction There is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature. Aim To report on self-inflicted penile amputation and comment on its surgical management and review current literature. Methods A 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue. Main Outcome Measures To review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes. Results We report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements. Conclusion We review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53. PMID:25844175

  17. Surgical Management of Ureteral Strictures Arising From Radiotherapy for Prostate Cancer

    PubMed Central

    Orchard, J.; Tward, Jonathan D.; Lenherr, Sara; Hotaling, James M.; Brant, William O.; Myers, Jeremy B.

    2016-01-01

    Ureteral strictures arising from radiotherapy for the treatment of prostate cancer are rare. We describe four cases of these ureteral strictures emphasizing pre-operative factors that may have contributed to development of the strictures, their ultimate surgical management, and the patients' short-term outcomes. PMID:27175344

  18. Outcome of surgical treatment of lumbar disc herniation in young individuals.

    PubMed

    Strömqvist, F; Strömqvist, B; Jönsson, B; Gerdhem, P; Karlsson, M K

    2015-12-01

    Lumbar disc herniation (LDH) is uncommon in youth and few cases are treated surgically. Very few outcome studies exist for LDH surgery in this age group. Our aim was to explore differences in gender in pre-operative level of disability and outcome of surgery for LDH in patients aged ≤ 20 years using prospectively collected data. From the national Swedish SweSpine register we identified 180 patients with one-year and 108 with two-year follow-up data ≤ 20 years of age, who between the years 2000 and 2010 had a primary operation for LDH. Both male and female patients reported pronounced impairment before the operation in all patient reported outcome measures, with female patients experiencing significantly greater back pain, having greater analgesic requirements and reporting significantly inferior scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects of Short Form-36 and Oswestry Disabilities Index, when compared with male patients. Surgery conferred a statistically significant improvement in all registered parameters, with few gender discrepancies. Quality of life at one year following surgery normalised in both males and females and only eight patients (4.5%) were dissatisfied with the outcome. Virtually all parameters were stable between the one- and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in both male and female patients aged 20 years or younger, who failed to recover after non-operative management. PMID:26637684

  19. Improving lung cancer outcomes by improving the quality of surgical care

    PubMed Central

    2015-01-01

    Surgical resection remains the most important curative treatment modality for non-small cell lung cancer, but variations in short- and long-term surgical outcomes jeopardize the benefit of surgery for certain patients, operated on by certain types of surgeons, at certain types of institutions. We discuss current understanding of surgical quality measures, and their role in promoting understanding of the causes of outcome disparities after lung cancer surgery. We also discuss the use of minimally invasive surgical resection approaches to expand the playing field for surgery in lung cancer care, and end with a discussion of the future role of surgery in a world of alternative treatment possibilities. PMID:26380183

  20. Surgical management of infected cardiac implantable electronic devices.

    PubMed

    Chaudhry, Umar A R; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Christina; Tsipas, Pantelis; Kokotsakis, John; Athanasiou, Thanos

    2016-01-15

    The growing use of cardiac implantable electronic devices (CIED) has led to infections requiring intervention. These are traditionally managed using a percutaneous transvenous approach to fully extract the culpable leads. Indications for such strategies are well-established and range from simple traction to the use of powered extraction tools including laser sheaths. Where such attempts fail, or if there are further complications, then there may be need for a cardiothoracic surgical approach. Limited evidence is currently available on the merits of individual strategies, and these are mainly drawn from case reports or series. Most utilise cardiopulmonary bypass, cardioplegic arrest and entry within the right atrium to allow direct visualisation of any vegetation and safely explant all CIED components whilst avoiding perforation, valvular and paravalvular damage. In this review, we describe a number of these and the unique challenges faced by surgeons when attempting to extract CIED. It is clear that future work should concentrate on creating clear consensus and guidelines on indications, risks and measures of efficacy outcomes for various surgical techniques. PMID:26590887

  1. Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

    PubMed Central

    Elzi, Luigia; Gurke, Lorenz; Battegay, Manuel; Widmer, Andreas F.; Weisser, Maja

    2014-01-01

    Objective Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. Methods This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. Results Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. Conclusions We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the

  2. Management of vitiligo patients with surgical interventions.

    PubMed

    Shokeen, Divya

    2016-05-01

    Vitiligo is an acquired depigmentation disorder of unknown etiology. Medical treatments are usually reasonably effective for nonstable vitiligo patches; however, for vitiligo patches that have been stable for a substantial period of time, surgical intervention should be considered. In this article, surgical interventions for vitiligo are reviewed, including split-thickness skin grafting, suction blister grafting, miniature punch grafting, and cultured melanocyte transplantation. PMID:27274556

  3. Surgical management of laryngomalacia: update 2000

    NASA Astrophysics Data System (ADS)

    Shah, Udayan K.

    2000-05-01

    Laryngomalacia is the most common cause of inspiratory stridor in children. This disease of excess tissue collapse most often does not require surgical correction. Surgery when necessary is best performed with the aid of the carbon dioxide (CO2) laser, delivered through a mirrored-arm micromanipulator- controlled system, while the supraglottis is exposed using a bivalved laryngoscope. This paper reviews the details of surgical technique used for the safe alleviation of airway distress due to larnyngomalacia.

  4. Surgical Management of the Pediatric Cochlear Implant Patient.

    ERIC Educational Resources Information Center

    Cohen, Seth M.; Haynes, David S.

    2003-01-01

    This article discusses the surgical management of children receiving cochlear implants. It identifies preoperative considerations to select patients likely to benefit, contraindications, some new surgical techniques, complications, special considerations (otitis media, meningitis, head growth, inner ear malformations, and cochlear obstruction).…

  5. Comparison of functional outcome of total hip arthroplasties involving four surgical approaches.

    PubMed

    Mostardi, R A; Askew, M J; Gradisar, I A; Hoyt, W A; Snyder, R; Bailey, B

    1988-01-01

    One hundred thirty-seven total hip arthroplasty patients had a follow-up evaluation consisting of an orthopaedic physical evaluation, isokinetic strength testing, and collection of demographic and surgical information from medical records. The intraoperative variables of surgical time and blood loss and the functional outcome status of the subjects, as demonstrated by D'Aubigne--Postel ratings and isokinetic strength tests, were compared for various trochanteric management techniques: no osteotomy; complete Charnley-type osteotomy; sharp abductor release; and a wafer technique, in which a wafer of bone was osteotomized from the trochanter to release the abductors. A comparison of the mean values for the variables indicated that the wafer and sharp techniques were superior to the complete and no osteotomy techniques. The wafer technique resulted in statistically significant superior isokinetic strength measured in adduction, flexion, and extension. Surgical time was significantly greater in the complete osteotomy cases and blood loss was least in the wafer cases, although these differences were not significant. PMID:3183682

  6. Surgical management of pericarditis in Zaria, Nigeria.

    PubMed Central

    Mabogunje, O A; Adesanya, C O; Khwaja, M S; Lawrie, J H; Edington, G M

    1981-01-01

    Over eight years, 58 rural Nigerians with pericarditis were treated surgically in Zaria using basic surgical facilities. Eighteen patients had purulent pericarditis, associated with staphylococcal pneumonia in children, or pneumococcal pneumonia in adults. Treatment with antibiotics and prompt pericardiectomy appeared to be superior to drainage, since a quarter of those initially treated with surgical drainage developed early constriction and required pericardiectomy soon after. Thirteen patients had chronic pericardial effusions, of whom one had epicardial constriction and two had cardiomyopathy. Twenty-seven patients had chronic constrictive pericarditis but tuberculosis was confirmed histologically in three only. Echocardiographic findings remained unchanged in five patients evaluated before and after pericardiectomy. Eight of the 13 patients who died had already developed myocardial or hepatic insufficiency before operation, because of late presentation or diagnosis. Greater awareness of the significance of precordial pain in this rural population where ischaemic heart disease is rare would help in making an earlier diagnosis. Images PMID:7314033

  7. The surgical management of peritoneal dialysis catheters.

    PubMed Central

    Brook, Nicholas R.; White, Steven A.; Waller, Julian R.; Nicholson, Michael L.

    2004-01-01

    Peritoneal dialysis is a safe and effective form of renal-replacement therapy. Its use is increasing as the gap widens between the number of patients waiting for renal transplants and the number of available organs. This article reviews the surgical considerations and complications of peritoneal dialysis that may present to general surgeons. PMID:15140305

  8. Medical and Surgical Management of Carney Complex.

    PubMed

    Siordia, Juan A

    2015-07-01

    Carney complex is a rare, autosomal dominant genetic disorder that consists of multiple myxomatous lesions and endocrine abnormalities, including skin lesions, cardiac myxomas, primary pigmented nodular adrenocortical disease, and acromegaly. This review discusses the medical and surgical treatment of patients with Carney complex. PMID:25996461

  9. Endoscopic Endonasal Dacryocystorhinostomy: Best Surgical Management for DCR.

    PubMed

    Bharangar, Sandeep; Singh, Nirupama; Lal, Vikram

    2012-12-01

    EEDCR is a highly rewarding Endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. There is very big advantage of EEDCR, it is close 100% successful procedure, even if there is recurrence of epiphora it is again correctable fully with no residual affects. EEDCR is far more superior to External DCR/Laser DCR and there are definite reasons for it. A total number of 578 cases have been operated by me from April 1, 2005 to March 31, 2011, only very few reoccurrences were there and they were corrected easily so much so that it can be said that it is a close 100% successful procedure and best surgical management of DACRYOCYSTITIS up to date. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing at the end of procedure and on follow up of patient. PMID:24294581

  10. Surgical and interventional management of complications caused by acute pancreatitis

    PubMed Central

    Karakayali, Feza Y

    2014-01-01

    Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience. PMID:25309073

  11. Surgical management of syringomyelia-Chiari complex.

    PubMed

    Ergün, R; Akdemir, G; Gezici, A R; Tezel, K; Beskonakli, E; Ergüngör, F; Taskin, Y

    2000-12-01

    Great variety exists in the indications and techniques recommended for the surgical treatment of syringomyelia-Chiari complex. More recently, magnetic resonance (MR) imaging has increased the frequency of diagnosis of this pathology and offered a unique opportunity to visualize cavities inside the spinal cord as well as their relationship to the cranio-cervical junction. This report presents 18 consecutive adult symptomatic syringomyelia patients with Chiari malformation who underwent foramen magnum decompression and syringosubarachnoid shunting. The principal indication for the surgery was significant progressive neurological deterioration. All patients underwent preoperative and postoperative MRI scans and were studied clinically and radiologically to assess the changes in the syrinx and their neurological picture after surgical intervention. All patients have been followed up for at least 36 months. No operative mortality was encountered; 88.9% of the patients showed improvement of neurological deficits together with radiological improvement and 11.1% of them revealed collapse of the syrinx cavity but no change in neurological status. None of the patients showed further deterioration of neurological function. The experience obtained from this study demonstrates that foramen magnum decompression to free the cerebro-spinal fluid (CSF) pathways combined with a syringosubarachnoid shunt performed at the same operation succeeds in effectively decompressing the syrinx cavity, and follow-up MR images reveal that this collapse is maintained. In view of these facts, we strongly recommend this technique, which seems to be the most rational surgical procedure in the treatment of syringomyelia-Chiari complex. PMID:11189926

  12. Surgical Management and Case-Fatality Rates of Intracerebral Hemorrhage in 1988 and 2005

    PubMed Central

    Adeoye, Opeolu; Woo, Daniel; Haverbusch, Mary; Sekar, Padmini; Moomaw, Charles J.; Broderick, Joseph; Flaherty, Matthew L.

    2009-01-01

    Objective To compare surgical management and case-fatality rates of intracerebral hemorrhage (ICH) in 1988 and 2005. Methods We identified all adult residents (age ≥18) from the five-county Greater Cincinnati region hospitalized with ICH in 1988 and 2005. Demographics, severity of illness, ICH volume, ICH location, rates and timing of surgery, and 30-day case-fatality were compared between the 1988 and 2005 groups. Results In 1988, 171 ICH patients met study criteria (67 lobar, 80 deep cerebral, 10 brainstem, 14 cerebellar), and in 2005, 259 ICH patients met criteria in (91 lobar, 123 deep cerebral, 19 brainstem, and 26 cerebellar). In 1988, 16% of the patients had surgical removal of their ICH versus 7% in 2005 (p=0.003). In both 1988 and 2005, patients treated with surgery were younger (p<0.001) and had a higher percentage of cerebellar hemorrhages than non-surgical patients. Timing of surgery was similar in 1988 and 2005. In 1988, 30-day case fatality was 32% in surgical patients versus 50% in non-surgical patients (p=0.06). In 2005, 30-day case-fatality was 16% (surgical) versus 45% (non-surgical) (p=0.02). Conclusion The frequency of surgery for ICH was lower in 2005 than in 1988, which may reflect recent clinical trial data showing no benefit for surgery over medical management. ICH case-fatality was essentially the same in 1988 and 2005. Innovative clinical trials to improve ICH outcomes are warranted. PMID:19057323

  13. Do Physical Symptoms Predict the Outcome of Surgical Fusion in Patients with Discogenic Low Back Pain?

    PubMed Central

    Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Aoki, Yasuchika; Nakamura, Junichi; Miyagi, Masayuki; Suzuki, Miyako; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Shiga, Yasuhiro; Abe, Koki; Fujimoto, Kazuki; Kanamoto, Hiroto; Inoue, Gen; Takahashi, Kazuhisa

    2016-01-01

    Study Design Retrospective case series. Purpose To determine whether symptoms predict surgical outcomes for patients with discogenic low back pain (DLBP). Overview of Literature Specific diagnosis of DLBP remains difficult. Worsening of pain on flexion is a reported symptom of DLBP. This study sought to determine whether symptoms predict surgical outcomes for patients with DLBP. Methods We investigated 127 patients with low back pain (LBP) and no dominant radicular pain. Magnetic resonance imaging was used to select patients with disc degeneration at only one level. If pain was provoked during discography, we performed fusion surgery (87 patients). Visual analogue scale score and responses to a questionnaire regarding symptoms including worsening of pain on flexion or extension were assessed. Symptom sites before surgery were categorized into LBP alone, or LBP plus referred inguinal or leg pain. We followed 77 patients (average 3.0 years) and compared symptoms before surgery with surgical outcome. Results Sixty-three patients with a good outcome showed postsurgical pain relief (≥60% pain relief) and 14 patients with a poor outcome did not (<60% pain relief). In patients with good outcomes, worsening of LBP was evident in 65% of cases on flexion and in 35% on extension. However, these findings were not significantly different from those in patients with poor outcomes. The percentage of patients with LBP alone was significantly lower and the percentage of patients with LBP plus referred inguinal or leg pain was significantly higher in the group with good surgical outcome compared with patients in the group with poor surgical outcome (p<0.05). Conclusions Worsening of pain on extension may be a symptom of DLBP. Surgical outcomes were superior in patients with both LBP and either referred inguinal or leg pain compared with those having LBP alone. PMID:27340531

  14. EACTS expert consensus statement for surgical management of pleural empyema.

    PubMed

    Scarci, Marco; Abah, Udo; Solli, Piergiorgio; Page, Aravinda; Waller, David; van Schil, Paul; Melfi, Franca; Schmid, Ralph A; Athanassiadi, Kalliopi; Sousa Uva, Miguel; Cardillo, Giuseppe

    2015-11-01

    Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard

  15. Tranexamic Acid in Anesthetic Management of Surgical Procedures.

    PubMed

    Mayeux, Jessica; Alwon, Kathy; Collins, Shawn; Hewer, Ian

    2016-06-01

    Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements. In addition, this journal course addresses concerns that use of antifibrinolytics increases embolic events, reviews research that demonstrates TXA does not increase the incidence of vascular occlusive events, and describes methods of TXA use in cardiac and orthopedic surgical procedures, neurosurgery, and obstetrics. The Certified Registered Nurse Anesthetist should consider the possibility, on a case-by-case basis, of using TXA in surgical procedures to reduce blood loss with minimal adverse effects. PMID:27501656

  16. Surgical Outcome of Excision and End-to-End Anastomosis for Bulbar Urethral Stricture

    PubMed Central

    Suh, Jun-Gyo; Choi, Woo Suk; Paick, Jae-Seung

    2013-01-01

    Purpose Although direct-vision internal urethrotomy can be performed for the management of short, bulbar urethral strictures, excision and end-to-end anastomosis remains the best procedure to guarantee a high success rate. We performed a retrospective evaluation of patients who underwent bulbar end-to-end anastomosis to assess the factors affecting surgical outcome. Materials and Methods We reviewed 33 patients with an average age of 55 years who underwent bulbar end-to-end anastomosis. Stricture etiology was blunt perineal trauma (54.6%), iatrogenic (24.2%), idiopathic (12.1%), and infection (9.1%). A total of 21 patients (63.6%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. Results Mean operation time was 151 minutes (range, 100 to 215 minutes) and mean excised stricture length was 1.5 cm (range, 0.8 to 2.3 cm). At a mean follow-up of 42.6 months (range, 8 to 96 months), 29 patients (87.9%) were symptom-free and required no further procedure. Strictures recurred in 4 patients (12.1%) within 5 months after surgery. Of four recurrences, one patient was managed successfully by urethrotomy, whereas the remaining three did not respond to urethrotomy or dilation and required additional urethroplasty. The recurrence rate was significantly higher in the patients with nontraumatic causes (iatrogenic in three, infection in one patient) than in the patients with traumatic etiology. Conclusions Excision and end-to-end anastomosis for short, bulbar urethral stricture has an acceptable success rate of 87.9%. However, careful consideration is needed to decide on the surgical procedure if the stricture etiology is nontraumatic. PMID:23878686

  17. Surgical Management of the Axilla in Breast Cancer.

    PubMed

    Mastrangelo, Stephanie; McMasters, Kelly; Ajkay, Nicolas

    2016-06-01

    This article offers a review of the literature on current surgical management of the axilla in breast cancer. This includes the decision-making process involved in clinically node-negative patients versus clinically node-positive patients, with discussion of the indications for sentinel lymph node biopsy versus axillary dissection. It also examines the surgical axillary management of patients who receive neoadjuvant chemotherapy. This article will help update practicing surgeons on the evolving research and guidelines for the management of breast cancer axillary disease. PMID:27305877

  18. Radiological and surgical management of thyroid neoplasms.

    PubMed

    Takami, H; Ikeda, Y; Miyabe, R; Okinaga, H; Kameyama, K; Fukunari, N

    2004-01-01

    Recent advances in the radiological diagnosis in thyroid neoplasms have been achieved by high-resolution ultrasonography and color-Doppler, and the ultrasound-guided fine-needle aspiration biopsy and ultrasound-guided percutaneous ethanol injection therapy have been developed on the basis of these modalities. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy have made minimally invasive thyroid surgery possible. The surgical procedures are classified into three main categories according to the approach, and each approach has its own advantages and disadvantages. Surgeons have to select the most suitable approach from one of these categories of approaches for each patient with a thyroid neoplasm. PMID:15271417

  19. Contemporary Surgical Management of Early Glottic Cancer.

    PubMed

    Hartl, Dana M; Brasnu, Daniel F

    2015-08-01

    For early-stage T1-T2 glottic squamous cell carcinoma, transoral laser microsurgery (TLM) is the main surgical modality, with rates of local control and laryngeal preservation ranging from 85% to 100% and low morbidity. For extensive lesions, open conservation laryngeal surgery may enable wider resections than TLM but at costs of longer hospital stay and higher postoperative morbidity. Surgery provides results that are comparable to nonsurgical treatment options while reserving radiation therapy for recurrences or second primary cancers, particularly in younger patients. In the future, transoral robot-assisted surgery may enable more extensive transoral resections than laser alone, decreasing further the indications for open surgery. PMID:26233790

  20. Surgical management of subcutaneous Colletotrichum gloeosporioides.

    PubMed

    Allton, David R; Parvez, Najma; Ranganath, Sangeetha; Jinadatha, Chetan

    2015-01-01

    A 52-year-old male patient with a history of sarcoidosis and over 10 years of chronic low-dose glucocorticoid use, cirrhosis and type 2 diabetes mellitus presented with two painful, enlarging subcutaneous nodules ultimately identified as Colletotrichum gloeosporioides. Two attempts at needle aspiration of the larger nodule resulted in rapid reaccumulation. Complete surgical excision of both nodules resulted in complete resolution without the use of any concomitant antifungals. Patient had no recurrence at 2 years of follow-up. PMID:25737220

  1. Thymoma: current medical and surgical management.

    PubMed

    Kesler, Kenneth A; Wright, Cameron D; Loehrer, Patrick J

    2004-03-01

    Thymoma is a rare neoplasm usually with an indolent growth pattern; however, local invasion and/or dissemination may occur. Surgery has been the standard of care for early stage disease with good to excellent cure rates anticipated. This neoplasm has been found to be relatively sensitive to cisplatinum-based chemotherapy as compared with most other epithelial tumors. Aggressive multimodality therapy therefore can result in long-term disease-free survival for patients presenting with locally advanced or even disseminated disease. This chapter outlines the current medical and surgical treatment options for thymoma. PMID:15229793

  2. Outcomes of Surgical Treatment of Vascular Anomalies on the Vermilion

    PubMed Central

    Park, Sang Min; Lee, Jae Woo; Kim, Hoon Soo; Lee, In Sook

    2016-01-01

    Background The vermilion plays an important role in both the aesthetic and functional aspects of facial anatomy. Due to its structural features, the complete excision of vascular anomalies on the vermilion is challenging, making it difficult to determine the appropriate treatment strategy. Thus, the authors analyzed the results of surgical treatment of vascular anomalies on the vermilion. Methods The medical records of 38 patients with vascular anomalies on the vermilion who underwent surgery from 1995 to 2013 were analyzed. Nine of the cases had an involuted hemangioma, and 29 cases had a vascular malformation; of the vascular malformations, 13, 11, one, and four cases involved were capillary malformations (CMs), venous malformations (VMs), lymphatic malformations (LMs), and arteriovenous malformations (AVMs), respectively. We investigated the surgical methods used to treat these patients, the quantity of surgical procedures, complications and instances of recurrence, and self-assessed satisfaction scores. Results A total of 50 operations were carried out: 28 horizontal partial excisions, eight vertical partial excisions, and 14 operations using other surgical methods. All cases of AVM underwent complete excision. Six cases experienced minor complications and one case of recurrence was observed. The overall average satisfaction score was 4.1 out of 5, while the satisfaction scores associated with each lesion type were 4.2 for hemangiomas, 3.9 for CMs, 4.2 for VMs, 5.0 for LMs, and 4.0 for AVMs. Conclusions It is difficult to completely excise vascular anomalies that involve the vermilion. This study suggests that partial excision focused on correcting the overall contour of the lips is effective and leads to satisfactory results. PMID:26848441

  3. Surgical management of third nerve palsy

    PubMed Central

    Singh, Anupam; Bahuguna, Chirag; Nagpal, Ritu; Kumar, Barun

    2016-01-01

    Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles. PMID:27433033

  4. Surgical management of recurrent ovarian cancer.

    PubMed

    Suh, Dong Hoon; Kim, Hee Seung; Chang, Suk-Joon; Bristow, Robert E

    2016-08-01

    Most patients with advanced-stage epithelial ovarian cancer will experience a relapse of disease despite a complete response after surgical cytoreduction and platinum-based chemotherapy. Treatment of recurrent ovarian cancer mainly comprises various combinations of systemic chemotherapy with or without targeted agents. The role of cytoreductive surgery for recurrent ovarian cancer is not well established. Although the literature on survival benefit of cytoreductive surgery for recurrent disease has expanded steadily over the past decade, most studies were retrospective, single-institution series with small numbers of patients. Given the balance between survival benefit and surgery-related morbidity during maximum cytoreductive surgical effort, it is essential to establish the optimal selection criteria for identifying appropriate candidates who will benefit from surgery without worsening quality of life. Three phase III randomized trials for this issue are currently underway. Herein, we present contemporary evidence supporting the positive role of cytoreductive surgery and offer selection criteria for optimal candidates for surgery in the treatment of recurrent ovarian cancer. PMID:27130407

  5. [Surgical management of intestinal Crohn's disease].

    PubMed

    Funayama, Yuji; Suzuki, Hideyuki; Takahashi, Ken-Ichi; Haneda, Sho; Watanabe, Kazuhiro; Ikezawa, Fumie; Unno, Michiaki

    2015-03-01

    Various intestinal conditions such as stricture, fistula, abscess, perforation, and hemorrhage are complications of Crohn's disease. Surgical intervention remains important, even in the era of biologic therapy. Limited surgical resection is essential to avoid short bowel syndrome after massive resection or multiple operations. Strictureplasty is effective for short, isolated stricture of the small intestine and provides good results equivalent to those of intestinal resection. Fecal diversion in the case of very complicated lesions not suitable for immediate resection can offer patients general and local improvement. Although bypass surgery is currently not performed because of the possibility of deterioration or carcinogenesis of the bypassed segment, bypass surgery is useful for avoiding stoma. Laparoscopic surgery is indicated for patients with nonperforating, localized ileocecal lesions, and for those presenting initially. The cumulative postoperative reoperation rate is about 50% to 60% at 10 years. The risk factors for early recurrence are smoking, perforating type, previous reoperation, and small intestinal disease. During postoperative follow-up and maintenance treatment, the importance of an algorithm comprising regular check-ups with ileocolonoscopy and the use of thioprines and biologics has been proposed. PMID:26050508

  6. An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women

    PubMed Central

    Keyhan, Sanaz; Hughes, Claude; Price, Thomas; Muasher, Suheil

    2015-01-01

    Ovarian endometriomas are a common manifestation of endometriosis that can represent a more severe stage of the disease. There is much debate over the treatment of these cysts in infertile women, particularly before use of assisted reproductive technologies. Evidence exists that supports surgical excision of ovarian endometriomas, as well as evidence that cautions against surgical intervention. Certain factors need to be examined closely before proceeding with surgery or continuing with expectant management. These include the patient's symptoms, age, ovarian reserve, size and laterality of the cyst, prior surgical treatment, and level of suspicion for malignancy. The most recent evidence appears to suggest that certain patient profiles may benefit from proceeding directly to in vitro fertilization (IVF). These include symptomatic infertile patients, especially those that are older, those that have diminished ovarian reserve, those that have bilateral endometriomas, or those that have had prior surgical treatment. Although endometriomas can be detrimental to the ovarian reserve, surgical therapy may further lower a woman's ovarian reserve. Nevertheless, the presence of an endometrioma does not appear to adversely affect IVF outcomes, and surgical excision of endometriomas does not appear to improve IVF outcomes. Regardless of treatment plan, infertile patients with endometriomas must be counseled appropriately before choosing either treatment path. PMID:26240817

  7. The Impact of Surgical Experience on Major Intraoperative Aneurysm Rupture and Their Consequences on Outcome: A Multivariate Analysis of 538 Microsurgical Clipping Cases

    PubMed Central

    Lee, Ming-Hsueh; Lee, Shih-Tseng; Chang, Chen-Nen; Lin, Chih-Lung; Hsu, Yung-Hsin; Huang, Yin-Cheng; Hsieh, Tsung-Che; Chang, Chee-Jen

    2016-01-01

    The incidence and associated mortality of major intraoperative rupture (MIOR) in intracranial aneurysm surgery is diverse. One possible reason is that many studies failed to consider and properly adjust the factor of surgical experience in the context. We conducted this study to clarify the role of surgical experience on MIOR and associated outcome. 538 consecutive intracranial aneurysm surgeries performed on 501 patients were enrolled in this study. Various potential predictors of MIOR were evaluated with stratified analysis and multivariate logistic regression. The impact of surgical experience and MIOR on outcome was further studied in a logistic regression model with adjustment of each other. The outcome was evaluated using the Glasgow Outcome Scale one year after the surgery. Surgical experience and preoperative Glasgow Coma Scale (GCS) were identified as independent predictors of MIOR. Experienced neurovascular surgeons encountered fewer cases of MIOR compared to novice neurosurgeons (MIOR, 18/225, 8.0% vs. 50/313, 16.0%, P = 0.009). Inexperience and MIOR were both associated with a worse outcome. Compared to experienced neurovascular surgeons, inexperienced neurosurgeons had a 1.90-fold risk of poor outcome. On the other hand, MIOR resulted in a 3.21-fold risk of unfavorable outcome compared to those without it. Those MIOR cases managed by experienced neurovascular surgeons had a better prognosis compared with those managed by inexperienced neurosurgeons (poor outcome, 4/18, 22% vs. 30/50, 60%, P = 0.013). PMID:27003926

  8. Clinical characteristics and post-surgical outcomes of focal cortical dysplasia subtypes.

    PubMed

    Xue, Hai; Cai, Lixin; Dong, Sheng; Li, Yongjie

    2016-01-01

    We retrospectively studied 105 patients with a focal cortical dysplasia (FCD) diagnosed on pathological examination, and investigated the long term postoperative seizure outcomes, different clinical characteristics of the three FCD subtypes, particularly type I and II, and surgical outcomes for each group. FCD is a common cause of drug-resistant epilepsy, which is divided into three different subtypes according to its involvement at different stages of brain development. Each of these groups may have different characteristics and may even have different surgical outcomes. After treatment, 55% of patients were completely seizure-free, with two significant predictive variables for poorer outcomes: focal MRI findings and electrode implantation. FCD type I had relatively poor surgical outcomes compared to FCD type II and type IIIa. Compared with FCD type I, type II, particularly IIb, had a higher frequency of seizure attacks, predominantly located in the extratemporal lobes, and was more readily detected and diagnosed via focal lesions on MRI and localized electroencephalogram abnormalities. FCD type II patients seem to show better surgical outcomes than FCD type I, but the difference was not significant. Larger cohort studies are needed for further evaluation of the seizure outcomes of different FCD subtypes. PMID:26314661

  9. Brainstem gangliogliomas: prognostic factors, surgical indications and functional outcomes.

    PubMed

    Pan, Chang-Cun; Chen, Xin; Xu, Cheng; Wu, Wen-Hao; Zhang, Peng; Wang, Yu; Wu, Tao; Tang, Jie; Xiao, Xin-Ru; Wu, Zhen; Zhang, Jun-Ting; Zhang, Li-Wei

    2016-07-01

    To explore the prognostic factors and discuss the surgical indications of brainstem gangliogliomas. Twenty-one patients with brainstem ganglioglioma were surgically treated at our hospital between 2006 and 2014. The clinical, radiological, operative, and pathological findings of these patients were retrospectively reviewed. The 3-years overall survival and event-free survival (EFS) rates were 90.5 % and 68.4 %, respectively. Four patients (4/18, 22 %) experienced a recurrence with a mean recurrence-free survival of 5.5 months and a mean follow-up of 37 months. Three patients died of surgery-related complications. Three growth patterns were identified: exophytic (6/21), intrinsic (2/21), and endo-exophytic (13/21). Eight patients (8/15, 53 %) harbored a BRAF V600E mutation. All recurrent tumors were endo-exophytic, and except the one without molecular information, were BRAF V600E mutants. A Cox hazard proportion ratio model was used to identify factors influencing EFS, including sex, age, location, growth patterns, extent of resection (EOR), and BRAF V600E mutation status. On univariate analysis, none of these factors reached statistical significance. Among them, EOR and growth patterns were strongly associated with each other (Fisher's exact test, P < 0.01). A multivariate analysis demonstrated that growth patterns were the only factor associated with EFS (P = 0.02; HR 49.05; 95 % CI 1.76-1365.13). Growth patterns may be useful to select surgery candidates and predict prognosis for patients with brainstem gangliogliomas. BRAF V600E was frequently present and appeared to be associated with shorter recurrence-free survival. Studies on BRAF V600E-targeted therapy for patients with high surgical risks are needed. PMID:27112924

  10. Prognostic factors of early outcome and discharge status in patients undergoing surgical intervention following traumatic intracranial hemorrhage.

    PubMed

    Fujii, Tatsuhiro; Moriel, Gabriela; Kramer, Daniel R; Attenello, Frank; Zada, Gabriel

    2016-09-01

    Over the past several decades, the rate of traumatic brain injury (TBI)-related emergency room visits in the United States has steadily increased, yet mortality in these patients has decreased. This improvement in outcome is largely due to advances in prehospital care, intensive care unit management, and the effectiveness of neurosurgical procedures, such as decompressive craniectomies. It is imperative to identify clinical factors predictive of patients who benefit from early mobilization of resources and operative treatment. Equally important is the identification of patients with good prognostic signs among patients receiving surgical intervention for TBI. We conducted a retrospective chart review of 181 patients requiring craniectomies and craniotomies for decompression or evacuation of an intracranial hemorrhage following TBI at a single level I trauma center between 2008-2010. Demographic features and perioperative clinical characteristics of these patients were examined in relation to favorable outcomes, defined as discharge to home or a rehabilitation facility, and unfavorable outcomes, defined as in-hospital mortality or discharge to step-down medical facilities. Younger age, greater Glasgow Coma Scale (GCS) score on admission, absence of preoperative coagulopathies, absence of hypernatremia, and absence of fever were all independent predictors of favorable outcome. Additionally, increased operative duration and increased length of hospital stay were identified as independent predictors of negative outcomes after surgery. This work supports some of the current prognostic models in the literature and identifies additional clinical variables with predictive value of early outcome and discharge status in patients undergoing surgical evacuation of traumatic intracranial hemorrhages. PMID:27424129

  11. Management of large mediastinal masses: surgical and anesthesiological considerations

    PubMed Central

    van Boven, Wim Jan P.; Annema, Jouke T.; Eberl, Susanne; Klomp, Houke M.; de Mol, Bas A.J.M.

    2016-01-01

    Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished. PMID:27076967

  12. Unfavourable outcomes in maxillofacial injuries: How to avoid and manage

    PubMed Central

    Parashar, Atul; Sharma, Ramesh Kumar

    2013-01-01

    Faciomaxillary injuries remain one of the common injuries managed by plastic surgeons. The goal of treatment in these injuries is the three-dimensional restoration of the disturbed anatomy so as to achieve pre-injury form and function. In this article, the authors review the anatomic, diagnostic and management considerations to optimise results and minimise the late post-traumatic deformities. Most of the adverse outcomes are usually a result of poorly addressed underlying structural injury during the primary management. An accurate physical examination combined with detailed computed tomographic scanning of the craniofacial skeleton is required to generate an appropriate treatment plan. This organised approach has proven effective in restoring the injured structures to pre-injury status. Multiple clinical cases are used to illustrate the different fracture patterns along with various surgical techniques to achieve an acceptable outcome. Early diagnosis and timely management of complications in these complex injuries is also discussed. PMID:24501458

  13. The role of unconscious bias in surgical safety and outcomes.

    PubMed

    Santry, Heena P; Wren, Sherry M

    2012-02-01

    Racial, ethnic, and gender disparities in health outcomes are a major challenge for the US health care system. Although the causes of these disparities are multifactorial, unconscious bias on the part of health care providers plays a role. Unconscious bias occurs when subconscious prejudicial beliefs about stereotypical individual attributes result in an automatic and unconscious reaction and/or behavior based on those beliefs. This article reviews the evidence in support of unconscious bias and resultant disparate health outcomes. Although unconscious bias cannot be entirely eliminated, acknowledging it, encouraging empathy, and understanding patients' sociocultural context promotes just, equitable, and compassionate care to all patients. PMID:22269267

  14. Short to Mid-Term Term Surgical Outcome Study with Posterior Only Approach on Tuberculous Spondylodiscitis in an Elderly Population

    PubMed Central

    Kothari, Manish; Tikoo, Agnivesh; Nene, Abhay

    2016-01-01

    Study Design Retrospective study. Purpose To study short to mid-term outcome of surgically managed elderly patients of tuberculous spondylodiscitis with posterior only approach in terms of decision making and challenges in treatment, choice of implants and outcomes. Overview of Literature Tuberculous spondylodiscitis in the elderly is increasing due to longer survival rates. It presents with varied clinical manifestations needing surgical management. Management in tuberculous spondylodiscitis has been scarcely reported in the elderly, with a paucity of data on the choice of implants and approach. Methods Sixteen patients (five males, 11 females) older than 70-years-of-age culture and/or histopathology proven tuberculous spondylodiscitis were included in the study. All patients were operated using a single posterior approach. Pedicle screw with rods (PS/rods) or spinal loop with sublaminar wires (SL/SLW) were used for fixation. Clinical and surgical details were recorded. Sagittal correction achieved postoperatively and loss of correction at follow-up were noted. Results The mean age was 73.6 years (range, 70 to 80 years). The mean follow up was 44.5 months (range, 24 to 84 months). The mean immediate postoperative correction of sagittal deformity was 11.3 degrees; this correction was lost by a mean of 3.1 degrees at last follow-up. All 10 patients with deficit showed neurological recovery and all but one of the seven non-walkers were capable of independent ambulation at follow-up. Patients with SL/SLW and PS/rods had similar radiological outcome at final follow up. Conclusions Operative management gives satisfactory results in elderly patients with tuberculous spondylodiscitis. The posterior approach provides adequate exposure for decompression and rigid fixation, providing satisfactory clinical and radiological outcomes. SSL/SLW and pedicle screw rod construct both give similar radiological results if used appropriately in patients. PMID:27114766

  15. Surgical Management of Absent Pulmonary Valve Syndrome.

    PubMed

    Jonas, Richard A

    2016-09-01

    The author's approach to the management of tetralogy of Fallot with absent pulmonary valve is described, including the technique of homograft replacement of the central pulmonary arteries for the neonate who presents with profound respiratory compromise. PMID:27587495

  16. Tracheoinnominate fistula: surgical management of an iatrogenic disaster.

    PubMed

    Ridley, R W; Zwischenberger, J B

    2006-08-01

    Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF. PMID:16709270

  17. State-of-the-Art Surgical Management of Acute Type A Aortic Dissection.

    PubMed

    El-Hamamsy, Ismail; Ouzounian, Maral; Demers, Philippe; McClure, Scott; Hassan, Ansar; Dagenais, Francois; Chu, Michael W A; Pozeg, Zlatko; Bozinovski, John; Peterson, Mark D; Boodhwani, Munir; McArthur, Roderick G G; Appoo, Jehangir J

    2016-01-01

    Acute type A aortic dissections still present a major challenge to cardiac surgeons. Although surgical management remains the gold standard, operative mortality remains high, including in experienced centres. Nevertheless, recent advances in the understanding and management of various aspects of these complex operations are expected to improve overall patient outcomes. The Canadian Thoracic Aortic Collaborative (CTAC) represents a group of surgeons with interest and expertise in the management of patients with aortic diseases. The purpose of this state-of-the-art review is to detail our approach to the contemporary surgical management of acute type A aortic dissections. We focus specifically on cannulation strategies, cerebral protection, and extent of proximal and distal resection. In addition, specific clinical scenarios-including malperfusion, intramural hematomas, and surgery in octogenarians-are explored. PMID:26604123

  18. Surgical Management of the Constricted or Obliterated Vagina.

    PubMed

    Gebhart, John B; Schmitt, Jennifer J

    2016-08-01

    Management of the constricted or obliterated vagina demands an understanding and recognition of the potential etiologies leading to this presentation. A thorough and comprehensive medical and surgical review is required to arrive at an accurate diagnosis, which then will guide medical or surgical intervention. It is paramount to recognize when underlying medical conditions are contributing to these conditions and to begin medical therapy; failure to do so will often yield suboptimal results. When these conditions arise after surgical interventions, compensatory surgical techniques that correct upper and lower vaginal strictures or obliteration include incision through the stricture, vaginal advancement, Z-plasty, skin grafts, perineal flaps, and abdominal flaps and grafts. Postoperative surveillance and dilation are critical to optimize long-term success. PMID:27399991

  19. Controversies in Surgical Management of Recalcitrant Enthesopathy of the Extensor Carpi Radialis Brevis.

    PubMed

    Gregory, Bonnie P; Wysocki, Robert W; Cohen, Mark S

    2016-08-01

    Enthesopathy of the extensor carpi radialis brevis, often referred to as "tennis elbow," is common and responds to nonsurgical treatment in 80% to 90% of patients within 1 year. For those who proceed with surgery, much remains unclear regarding the ideal treatment. This paper discusses controversies in surgical management of extensor carpi radialis brevis enthesopathy including clinical outcomes of open versus arthroscopic techniques, the relevance of concomitant pathology addressed arthroscopically, and avenues for assessing comparative cost data. PMID:27491631

  20. Contemporary Surgical Management of Severe Sialorrhea in Children

    PubMed Central

    Hornibrook, Jeremy; Cochrane, Neil

    2012-01-01

    The causes of severe sialorrhea (drooling) are reviewed, and in particular in children in whom it can become a life-long disability. The history of medical and surgical treatments is discussed. A major advance has been the surgical relocation of the submandibular gland ducts with removal of sublingual glands. The results of this operation, technical considerations, and its outcomes in 16 children are presented. There were no significant complications. Caregivers judged the efficacy with a median score of “75%” improvement. The technique has become the most logical and reliable surgical treatment for drooling, with very good control in most cases. In contrast to “Botox” its effects are permanent. PMID:22548185

  1. Pain management in the pediatric surgical patient.

    PubMed

    Sohn, Vance Y; Zenger, David; Steele, Scott R

    2012-06-01

    Surgeons performing painful, invasive procedures in pediatric patients must be cognizant of both the potential short- and long-term detrimental effects of inadequate analgesia. This article reviews the available tools, sedation procedures, the management of intraoperative, postoperative, and postprocedural pain, and the issues surrounding neonatal addiction. PMID:22595704

  2. Prognostication of Learning Curve on Surgical Management of Vasculobiliary Injuries after Cholecystectomy

    PubMed Central

    Dar, Faisal Saud; Zia, Haseeb; Rafique, Muhammad Salman; Khan, Nusrat Yar; Salih, Mohammad; Hassan Shah, Najmul

    2016-01-01

    Background. Concomitant vascular injury might adversely impact outcomes after iatrogenic bile duct injury (IBDI). Whether a new HPB center should embark upon repair of complex biliary injuries with associated vascular injuries during learning curve is unknown. The objective of this study was to determine outcome of surgical management of IBDI with and without vascular injuries in a new HPB center during its learning curve. Methods. We retrospectively reviewed patients who underwent surgical management of IBDI at our center. A total of 39 patients were included. Patients without (Group 1) and with vascular injuries (Group 2) were compared. Outcome was defined as 90-day morbidity and mortality. Results. Median age was 39 (20–80) years. There were 10 (25.6%) vascular injuries. E2 injuries were associated significantly with high frequency of vascular injuries (66% versus 15.1%) (P = 0.01). Right hepatectomy was performed in three patients. Out of these, two had a right hepatic duct stricture and one patient had combined right arterial and portal venous injury. The number of patients who developed postoperative complications was not significantly different between the two groups (11.1% versus 23.4%) (P = 0.6). Conclusion. Learning curve is not a negative prognostic variable in the surgical management of iatrogenic vasculobiliary injuries after cholecystectomy. PMID:27525124

  3. Surgical management of metabolic dysfunction in PCOS.

    PubMed

    Escobar-Morreale, Héctor F

    2012-03-10

    Metabolic disturbances are common in women with polycystic ovary syndrome (PCOS). Obesity is the major link in the association of PCOS with diabetes, metabolic syndrome, hypertension, low-grade chronic inflammation and increased body iron stores, among others. Metabolic prevention in PCOS women should start as early as possible, usually meaning at diagnosis. Among preventive strategies, those promoting a healthy life-style based on diet, regular exercising and smoking cessation are possibly the most effective therapies, but also are the most difficult to achieve. To this regard, every effort must be made to avoid weight gain and obesity, given the deleterious impact that obesity exerts on the metabolic and cardiovascular associations of PCOS. Unfortunately, classic strategies that address obesity by life-style modification and dieting are seldom successful on a long-term basis, especially in women with severe obesity. In selected cases, metabolic surgery in severely obese women may resolve signs and symptoms of PCOS restoring insulin sensitivity and fertility, and avoiding the long-term risks associated with PCOS and morbid obesity. Surgical techniques for bariatric surgery have evolved in the past decades and newer procedures do not longer carry the severe side effects associated with earlier bariatric procedures. The choice of bariatric procedure should consider both the severity of obesity and the possibility of future pregnancy, since fertility may be restored by the sustained and marked weight loss usually attained after bariatric surgery. Finally, avoidance of the risks associated with morbid obesity compensate for the possible residual risks for pregnancy derived from the previous bariatric procedure itself. PMID:22172592

  4. Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome

    PubMed Central

    Kwon, Young Sub; Yang, Kook Hee

    2016-01-01

    Objective Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural hematomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experience. To clarify this point, we analyzed preoperative findings and surgical outcome of patients with ASDH treated with CO or DC. Methods From January 2010 to December 2014, data for 46 patients with ASDH who underwent CO or DC were retrospectively reviewed. The demographic, clinical, imaging and clinical outcomes were analyzed and statistically compared. Results Twenty (43%) patients underwent CO and 26 (57%) patients received DC. In DC group, preoperative Glascow Coma Scale was lower (p=0.034), and more patient had non-reactive pupil (p=0.004). Computed tomography findings of DC group showed more frequent subarachnoid hemorrhage (p=0.003). Six month modified Rankin Scale showed favorable outcome in 60% of CO group and 23% of DC group (p=0.004). DC was done in patient with more unfavorable preoperative features (p=0.017). Patients with few unfavorable preoperative features (<6) had good outcome with CO (p<0.001). Conclusion In selective cases of few unfavorable clinical findings, CO may also be an effective surgical option for ASDH. Although DC remains to be standard of surgical modality for patients with poor clinical status, CO can be an alternative considering the possible complications of DC. PMID:27182498

  5. Factors influencing surgical outcome after anterior stabilization of the cervical spine with heterogeneous material

    PubMed Central

    Petridis, Athanasios K.; Sechting, Sabrina; Budde, Michael; Doukas, Alexandros; Maslehaty, Homajoun; Mehdorn, Hubertus Maximilian

    2012-01-01

    Intervertebral fusion through an anterior approach with polymethylacrylate is a well-established neurosurgical technique in the treatment of cervical spine degeneration. However, questions still remain concerning the post-surgical outcome. Factors influencing surgical outcome that could help to predict which patients need further post-surgical treatment and what to expect after surgery are the subject of numerous studies. In the present study, we retrospectively collected data from patients who had undergone intervertebral fusion and defined which pre-operative factors could influence the surgical outcome. Between 1993 and 1997, 379 patients were surgically treated with the ventral fusion technique in our hospital. In 2006, we sent a questionnaire to the patients and 164 responses were received. We identified pre-operative presence of severe pain, hypesthesia, palsy and gait disturbance as negative predictive factors, whereas age, body mass index, pre-operative physical strain and the cervical segment involved did not seem to influence prognosis. In conclusion, identifying pre-operative factors which influence prognosis after intervetebral fusion will help predict postoperative outcome. PMID:24765459

  6. Conservative surgical treatment of adenomyosis to improve fertility: Controversial values, indications, complications, and pregnancy outcomes.

    PubMed

    Tsui, Kuan-Hao; Lee, Fa-Kung; Seow, Kok-Min; Chang, Wei-Chun; Wang, Jia-Wei; Chen, Shee-Uan; Chao, Hsiang-Tai; Yen, Min-Shyen; Wang, Peng-Hui

    2015-12-01

    Uterine adenomyosis was first reported in the 19(th) century and early 20(th) century; von Rokitansky described it in 1860. Since then, the general clinical, pathological, and radiologic findings and potentially useful management methods have been reviewed in many studies. Some authors commented that conservative surgical treatment is impracticable as it is not possible to isolate the adenomyotic tissue adequately; therefore, the authors suggested that hysterectomy is the only rational and complete procedure. There is more evidence supporting the advantages of conservative uterine-sparing surgery in providing not only more effective symptom relief, but also longer durable symptom control for symptomatic women with uterine adenomyosis, because the main problem secondary to uterine adenomyosis, dysmenorrhea, can be improved significantly, up to 80%. Menorrhea was also improved in more than two-thirds of patients after type I uterine-sparing surgery, and half of the patients saw benefit in symptom control after type II conservative uterine-sparing surgery. In addition, there was no negative impact on reproductive performance after conservative uterine-sparing surgery, and in fact, reproductive performance seemed to be improved compared with that after medical treatment-not only was there a higher cumulative pregnancy rate, but also a higher cumulative final successful delivery rate. However, there is no doubt that the data supporting the above-mentioned benefits for symptomatic women with uterine adenomyosis after conservative uterine-sparing surgery are limited, suggesting that the benefit may be moderate. In fact, one of the main indications for surgery is temporary pain relief in women seeking spontaneous conception. However, the effect of surgery on pain is usually only temporarily satisfactory, and the risk of complications varies according to the type of lesion extirpated. In light of this, an extensive review of this topic addressing conservative surgical

  7. Surgical Management of Bilateral Limbal Stem Cell Deficiency.

    PubMed

    Vazirani, Jayesh; Mariappan, Indumathi; Ramamurthy, Shreyas; Fatima, Saba; Basu, Sayan; Sangwan, Virender S

    2016-07-01

    Limbal stem cell deficiency (LSCD) is now established as a distinct entity with a spectrum of clinical manifestations. Bilateral LSCD presents a unique set of challenges to the clinician dealing with ocular surface disease, due to the underlying causes, clinical presentation, and adnexal status, as well as lack of a source of autologous limbal stem cells. Various surgical modalities have been described to achieve visual rehabilitation in patients with bilateral LSCD. These can primarily be divided into cell-based therapies and implantation of keratoprostheses. In this review, the surgical options for management of bilateral LSCD, including autologous and allogeneic cell-based therapies and different types of keratoprostheses are described and classified. The indications, prerequisites, technique, results and complications of each modality are discussed. Based on the status of the ocular surface, an algorithm for choosing appropriate surgical management for vision restoration in bilateral LSCD has been proposed. PMID:27151421

  8. Review article: Risk factors for poor outcome following surgical treatment for rotator cuff tear.

    PubMed

    Sahni, V; Narang, A M

    2016-08-01

    The Medline database was searched using key words: 'rotator cuff', 'tear', and 'treatment'. 12 studies that involved (1) surgical treatment for rotator cuff tear, (2) measurement of pre- and post-operative pain score, functional score, and/or patient satisfaction, (3) patients that failed to improve functionally or had poor satisfaction, (4) preoperative examination of risk factors that could lead to poor outcome, and (5) a minimum follow-up of 6 months were reviewed to identify risk factors associated with poor outcome following surgical treatment for rotator cuff tear. The most common risk factor was tear size, followed by open compensation claim, age, and time from injury to surgery. PMID:27574276

  9. SURGICAL MANAGEMENT OF RETROPERITONEAL AND PELVIC SARCOMAS

    PubMed Central

    Tan, Marcus C. B.; Yoon, Sam S.

    2014-01-01

    Management of retroperitoneal sarcomas presents technical and oncological challenges. Imaging is crucial for diagnosis and to define local tumor extent. Complete gross resection at initial presentation is the best chance for cure, but there is controversy as to how this can be best achieved. There is a long-term risk of local recurrence, which is best treated with repeat resection if feasible. The roles of radiation and chemotherapy remain undefined. PMID:25482329

  10. The Impact of Neoadjuvant Treatment on Surgical Options and Outcomes.

    PubMed

    Ataseven, Beyhan; von Minckwitz, Gunter

    2016-10-01

    Neoadjuvant systemic therapy (NST) has become a well-established treatment method for patients with breast cancer, not only for those with large tumors, but also for patients with early high-risk cancers. In earlier times, the clinical advantage of NST was seen in improvement of tumor shrinkage for better operability, conversion of mastectomy candidates to breast conservation, and optimization of cosmetic results. Over the decades, therapy regimens were optimized, resulting in significantly higher response rates. Rates for breast conservation and for conversion from mastectomy to breast conservation, especially for patients with advanced breast cancers, rose significantly for patients undergoing NST. A multidisciplinary approach with close and accurate diagnostic assessment of the breast, axillary tumor, or both during NST and individual-response-guided surgery is mandatory. To reduce unnecessary surgery and prevent mastectomies, more conclusive prediction models and minimally invasive methods for selection of patients with pathologic complete remission after NST are needed. Furthermore, prospective studies demonstrate that sentinel node biopsy for patients with initial clinically node-positive axillary nodes converting to clinically node-negative axillary nodes is oncologically safe and offers less morbidity, avoiding complete axillary node dissection. Initial concerns regarding surgical complications and morbidity due to potential immune frailty of patients with NST were not observed. PMID:27364505

  11. Unstable angina: comparison of medical and surgical management.

    PubMed

    Hultgren, H N; Pfeifer, J F; Angell, W W; Lipton, M J; Bilisoly, J

    1977-05-01

    Medical versus surgical treatment of unstable angina was compared in a prospective nonrandomized study of 118 patients. Acute transient ST-T wave changes were present during chest pain in all patients. Acute infarction was excluded by serial electrocardiograms and enzyme studies. All patients admitted to the coronary care unit from 1970 to 1975 who fulfilled the entry criteria were included in the study. The starting point for data evaluation was 5 days after hospital admission. Characteristics at entry were similar in 66 medically treated patients and 52 patients who had coronary bypass vein graft surgery. During a mean follow-up period of 23 months in 66 medically treated patients with unstable angina the incidence rate of nonfatal myocardial infarction was 17% and the total mortality rate 21 percent compared with respective rates of 19% and 5.8% in 52 surgically treated patients. In the surgical group 8 patients (15%) had a perioperative infarction and only 2 (4%) had a late infarction; one patient (2%) died at operation. Symptomatic improvement was observed more frequently in the surgically treated group. Sixty percent of surgically treated patients were free of angina compared with 21% of medically treated patients. Eight medically treated patients (12%) required late surgical treatment for persistent severe angina despite optimal medical management. PMID:67799

  12. Retinal Detachment in Down Syndrome: Characteristics and Surgical Outcomes

    PubMed Central

    AlAhmadi, Badr O.; Alsulaiman, Sulaiman M.; Arevalo, J. Fernando

    2016-01-01

    Purpose. To determine the functional and anatomic outcomes of rhegmatogenous retinal detachment (RRD) surgery in patients with Down syndrome. Methods. A retrospective chart review was performed of patients with Down syndrome who had undergone surgery for RRD at King Khalid Eye Specialist Hospital between 1995 and 2014. Results. A total of 245 patients with Down syndrome were evaluated during the study period. Eighteen eyes of 15 patients (6.1%) with RRD were identified. Three out of 15 patients (20%) presented with bilateral retinal detachment. All eyes presented with macula off retinal detachment. The retina was successfully reattached in 16/18 (88.8%) eyes after a mean follow-up of 48 months. The final postoperative visual acuity ranged from light perception to 20/125 (median: hand motion) (11/18 eyes). Conclusions. The anatomic success rate of retinal reattachment surgery in patients with Down syndrome is comparable to the general population. Patients with Down syndrome should undergo regular ophthalmic examinations for early diagnosis. Despite late diagnosis and the presence of proliferative vitreoretinopathy (PVR) in some patients, favorable anatomical outcomes can be achieved. PMID:27123341

  13. Retinal Detachment in Down Syndrome: Characteristics and Surgical Outcomes.

    PubMed

    AlAhmadi, Badr O; Alsulaiman, Sulaiman M; Arevalo, J Fernando

    2016-01-01

    Purpose. To determine the functional and anatomic outcomes of rhegmatogenous retinal detachment (RRD) surgery in patients with Down syndrome. Methods. A retrospective chart review was performed of patients with Down syndrome who had undergone surgery for RRD at King Khalid Eye Specialist Hospital between 1995 and 2014. Results. A total of 245 patients with Down syndrome were evaluated during the study period. Eighteen eyes of 15 patients (6.1%) with RRD were identified. Three out of 15 patients (20%) presented with bilateral retinal detachment. All eyes presented with macula off retinal detachment. The retina was successfully reattached in 16/18 (88.8%) eyes after a mean follow-up of 48 months. The final postoperative visual acuity ranged from light perception to 20/125 (median: hand motion) (11/18 eyes). Conclusions. The anatomic success rate of retinal reattachment surgery in patients with Down syndrome is comparable to the general population. Patients with Down syndrome should undergo regular ophthalmic examinations for early diagnosis. Despite late diagnosis and the presence of proliferative vitreoretinopathy (PVR) in some patients, favorable anatomical outcomes can be achieved. PMID:27123341

  14. Surgical outcome and prognostic factors in patients with gallbladder carcinoma

    PubMed Central

    Hong, Eun Kyung; Kim, Kun Kuk; Lee, Jung Nam; Lee, Woon Kee; Chung, Min; Kim, Yeon Suk

    2014-01-01

    Backgrounds/Aims Gallbladder carcinoma is usually associated with an unfavorable prognosis, and the clinical outcome has not improved much. This study was conducted to evaluate outcomes with gallbladder carcinoma according to the type of surgery performed, and the prognostic factors for survival. Methods One hundred and six patients with gallbladder carcinoma, who underwent surgery for the purpose of curative resection between January 1999 and June 2012 were reviewed retrospectively. Results Out of 106 patients, curative resection was achieved in 75 (70.8%). The cumulative 1-, 2- and 5-year survival rates of the gallbladder carcinoma patients were 93.4%, 80.9% and 63.0%, respectively. Radical resections, including extended cholecystectomy, were more beneficial for long term survival of patients. The 5-year survival rate in patients who underwent curative resection (56.9%) was significantly higher than in those who underwent palliative resection (0%, p=0.000). Multivariate analysis revealed that curative resection, preoperative CA19-9, T-stage, N-stage and differentiation of histology were independently significant prognostic factors. Conclusions Curative resection and early detection of patients with gallbladder carcinoma were the most important factors for long term survival. Radical resection improves survival for patients with localized gallbladder carcinoma and can help to access exact prognosis and treatments. PMID:26155265

  15. Diagnosis and Surgical Management of Uroenteric Fistula.

    PubMed

    Gill, Harcharan S

    2016-06-01

    Uroenteric fistulae can occur between any part of the urinary tract and the small and large bowel. Classification is generally based on the organ of origin in the urinary tract and the termination of the fistula in the segment of the gastrointestinal tract. Surgery is often necessary. Congenital fistulae are rare, with most being acquired. Uroenteric fistulae most frequently occur in a setting of inflammatory bowel disease. Imaging often helps in the diagnosis. Management of urinary fistulae includes adequate nutrition, diversion of the urinary tract, diversion of the gastrointestinal tract, treatment of underling inflammatory process or malignancy, and surgery. PMID:27261796

  16. Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score

    PubMed Central

    Aggarwal, Rishi Anil; Srivastava, Sudhir Kumar; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings, following

  17. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery.

    PubMed

    Montravers, Philippe; Augustin, Pascal; Zappella, Nathalie; Dufour, Guillaume; Arapis, Konstantinos; Chosidow, Denis; Fournier, Pierre; Ribeiro-Parienti, Lara; Marmuse, Jean-Pierre; Desmard, Mathieu

    2015-02-01

    Perioperative complications following bariatric surgery (BS) have been poorly analysed and their management is not clearly assessed. The associated frequency of ICU admission is difficult to estimate. Among surgical complications, digestive perforations are the most frequent. The most common postoperative complications of sleeve gastrectomy are fistulas, but bleeding on the stapling line is also commonly reported. Complication rates are higher after Roux-en-Y gastric bypass, mainly due to anastomotic leaks. Medical complications are mainly thromboembolic or respiratory complications. All these surgical and medical complications are not easily detected; clinical signs can be atypical or insidious, often resulting in delayed management. Respiratory signs can be predominant and lead erroneously to pulmonary or thromboembolic diseases. Diagnostic criteria are based on minor clinical signs, tachycardia being probably the most frequent one. Lately, complications are revealed by haemodynamic instability, respiratory failure or renal dysfunction and radiographic findings. Management decision according to these abnormal signs is based on a combined multidisciplanary approach including surgical and/or endoscopic procedures and medical care, depending on the nature and severity of the surgical complication. Medical management is based on supportive ICU care of organ dysfunctions, curative anticoagulation if required, nutritional support, and appropriate anti-infective therapy. Pharmacological data are limited in morbidly obese patients and the appropriate doses are debated, especially for anti-infective agents. Complicated BS cases have a poor outcome, probably largely related to delayed diagnosis and reoperation. PMID:25829315

  18. The surgical management of spontaneous esophageal perforation (Boerhaave's syndrome) ‒ 20 years of experience.

    PubMed

    Pezzetta, Edgardo; Kokudo, Takashi; Uldry, Emilie; Yamaguchi, Takamune; Kudo, Hiroki; Ris, Hans-Beat; Christodoulou, Michel; Vuilleumier, Henri; Halkic, Nermin

    2016-05-23

    Spontaneous esophageal perforation (Boerhaave's syndrome) is an uncommon and challenging condition with significant morbidity and mortality. Surgical treatment is indicated in the large majority of cases and different procedures have been described in this respect. We present the results of a mono-institutional evaluation of the management of spontaneous esophageal perforation over a 20-year period. The charts of 25 patients with spontaneous esophageal perforation treated at the Surgical Department of the University Hospital of Lausanne were retrospectively studied. In the 25 patients, 24 patients were surgically treated and one was managed with conservative treatment. Primary buttressed esophageal repair was performed in 23 cases. Nine postoperative complications were recorded, and the overall mortality was 32%. Despite prompt treatment postoperative morbidity and mortality are still relevant. Early diagnosis and definitive surgical management are the keys for successful outcome in the management of spontaneous esophageal perforation. Primary suture with buttressing should be considered as the procedure of choice. Conservative approach may be applied in very selected cases. PMID:27052150

  19. Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

    PubMed Central

    Huang, Long; Yu, Qing-Sheng; Zhang, Qi; Liu, Ju-Da; Wang, Zhen

    2015-01-01

    Background: The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension. Methods: All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges. Results: The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] = 7.45, 95% confidence interval[CI]: (3.93–14.15), P < 0.00001), the same outcomes were seen in shunt stenosis (OR = 20.01, 95% CI: (6.67–59.99), P < 0.000001) and in hepatic encephalopathy (OR = 2.50, 95% CI: (1.63–3.84), P < 0.0001). Significantly better 2-year survival (OR = 0.66; 95% CI: (0.44–0.98), P = 0.04) and 5-year survival (OR = 0.44; 95% CI: (0.30–0.66), P < 0.00001) were seen in patients undergoing surgical shunting compared with TIPS. Conclusions: Compared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS. PMID:25758281

  20. Recognition and Surgical Techniques for Management of Nonrecurrent Laryngeal Nerve during Carotid Endarterectomy.

    PubMed

    Jimenez, Juan Carlos; Jabori, Sinan; Gelabert, Hugh A; Moore, Wesley S; Quinones-Baldrich, William J; O'Connell, Jessica

    2016-05-01

    The presence of a nonrecurrent laryngeal nerve (NRLN) during carotid endarterectomy (CEA) may significantly limit the exposure of the surgical field during this operation. Although its reported incidence is rare, NRLN typically overlies the carotid bifurcation and failure to recognize this anatomic variation increases the risk of NRLN injury. A retrospective chart review of all patients who underwent CEA for hemodynamically significant extracranial carotid stenosis between January 2005 and December 2014 was performed. All patients with NRLN encountered intraoperatively were identified. Clinical outcomes, surgical techniques, and complications were reviewed and reported. Four left-sided NRLN were identified and 4 were right sided. No cranial nerve deficits or injuries occurred after CEA in patients where NRLN was encountered. Two distinct surgical techniques were used to manage patients with NRLN and they are discussed in detail. PMID:26965812

  1. Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review

    PubMed Central

    Pereira, Nigel; Petrini, Allison C.; Lekovich, Jovana P.; Elias, Rony T.; Spandorfer, Steven D.

    2015-01-01

    Endometrial polyps are benign localized lesions of the endometrium, which are commonly seen in women of reproductive age. Observational studies have suggested a detrimental effect of endometrial polyps on fertility. The natural course of endometrial polyps remains unclear. Expectant management of small and asymptomatic polyps is reasonable in many cases. However, surgical resection of endometrial polyps is recommended in infertile patients prior to treatment in order to increase natural conception or assisted reproductive pregnancy rates. There is mixed evidence regarding the resection of newly diagnosed endometrial polyps during ovarian stimulation to improve the outcomes of fresh in vitro fertilization cycles. Hysteroscopy polypectomy remains the gold standard for surgical treatment. Evidence regarding the cost and efficacy of different methods for hysteroscopic resection of endometrial polyps in the office and outpatient surgical settings has begun to emerge. PMID:26301260

  2. Surgical Management of Orthopedic and Musculoskeletal Diseases of Feedlot Calves.

    PubMed

    Anderson, David E; Miesner, Matt D

    2015-11-01

    Injuries, infections, and disorders of the musculoskeletal system are common in feedlot calves. These conditions often are amenable to surgical treatment with return of the calf to productivity. Weight gain and carcass quality are expected to be significantly adversely affected by pain and debilitation. The goal of surgical management of disorders of the joints, muscles, and feet should be resolution of the inciting cause, mitigation of pain, and restoration of form and function. If these are achieved, calves should return to acceptable, if not normal, feed intake, rate of gain, and carcass quality. PMID:26210767

  3. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients.

    PubMed

    Oakland, K; Nadler, R; Cresswell, L; Jackson, D; Coughlin, P A

    2016-02-01

    Introduction Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. Methods A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement. Results Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62-4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49-2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02-2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41-9.55). Conclusions The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients. PMID:26741674

  4. Oncological and surgical outcome of total laryngectomy in combination with neck dissection in the elderly.

    PubMed

    Teymoortash, Afshin; Bohne, Franziska; Kissing, Lena; Daniel, Hanna; Kurt, Bilgen; Wilhelm, Thomas; Halmos, Gyorgy B; Hoch, Stephan

    2016-07-01

    There are controversial data on oncological and surgical outcome after major head and neck cancer surgery in the elderly. The aim of this study was to evaluate the outcome of elderly cancer patients after total laryngectomy in combination with neck dissection. A total of 58 patients separated into two age groups (28 < 65 vs. 30 ≥ 65 years) with hypopharyngeal and laryngeal cancer who underwent total laryngectomy and neck dissection were enrolled. Comorbidities of both age groups using the Charlson comorbidity index, hospitalization days as well as surgical complications evaluated by the Clavien-Dindo classification were examined. Overall and disease-free survivals of all patients were analyzed. The average follow-up was 2.9 years. Surgical complication rate was significantly increased in elderly (p = 0.04). However, complications could be treated without surgical intervention in most cases without significant extension of hospitalization. Locoregional and distant control did not significantly differ in both age groups. Disease-free and overall survival showed no significant differences for the two age groups by the Kaplan-Meier analysis (p = 0.66 and 0.08, respectively). Total laryngectomy in combination with neck dissection can be considered in elderly patients with satisfactory oncological and surgical outcome. PMID:26972426

  5. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity

    PubMed Central

    Zhang, JingTao; Wang, LinFeng; Li, Jie; Yang, Peng; Shen, Yong

    2016-01-01

    The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery. PMID:26960572

  6. Patterns of coordination and clinical outcomes: a study of surgical services.

    PubMed Central

    Young, G J; Charns, M P; Desai, K; Khuri, S F; Forbes, M G; Henderson, W; Daley, J

    1998-01-01

    OBJECTIVE: To test the hypothesis that surgical services combining relatively high levels of feedback and programming approaches to the coordination of surgical staff would have better quality of care than surgical services using low levels of both coordination approaches as well as those surgical service using low levels of either coordination approach. STUDY SETTING: A study sample of 44 academically affiliated surgical services that are part of the Department of Veterans Affairs. STUDY DESIGN: In a cross-sectional analysis, surgical services were assigned to one of three groups based on their scores on feedback and programming coordination measures: high on both measures; high on one measure, low on the other; and low on both. Univariate and multivariate analyses were used to assess differences among these groups with respect to three quality indicators: risk-adjusted mortality, risk-adjusted morbidity, and staff perceptions of quality. DATA COLLECTION/EXTRACTION METHODS: Risk-adjusted mortality and morbidity came from an outcomes reporting program within the Department of Veterans Affairs that entails the prospective collection of clinical data from patient charts. Data on coordination practices and perceived quality came from a survey of surgical staff at each of the 44 participating surgical services. PRINCIPAL FINDINGS: The group of surgical services using high feedback and high programming had the best perceived quality. This group also had the lowest morbidity, but the difference was statistically significant with respect to only one of the two other groups: the group with low feedback and low programming. No significant group differences were found for mortality. CONCLUSIONS: Study results provide partial support for the hypothesis that high levels of feedback and programming should be combined for optimal quality of care. Study results also suggest that staff coordination is more important for improving morbidity than mortality in surgical services. PMID

  7. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

    PubMed Central

    Petis, Stephen; Howard, James L.; Lanting, Brent L.; Vasarhelyi, Edward M.

    2015-01-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of THA, although their relative risk varies by approach. Numerous clinical trials have sought to elicit differences in patient-reported outcomes, complication rates and return to function among the surgical approaches. This review outlines some of the technical pearls of performing a THA through either a direct anterior, direct lateral or posterior approach. A literature review outlines the impact of surgical approach on clinical outcomes and clinically relevant complication rates. PMID:25799249

  8. A study of clinical and information management processes in the surgical pre-assessment clinic

    PubMed Central

    2014-01-01

    Background Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. Methods As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team. Results The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team. Conclusion Successful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully

  9. ‘Minimum-incision’ endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes

    PubMed Central

    El-Karamany, Tarek M.; Al-Adl, Ahmed M.; Abdel-Baky, Shabieb A.; Abdel-Azeem, Abdallah F.; Zaazaa, Mohamed A.

    2014-01-01

    Objective To describe the surgical technique and report the early outcomes of a ‘minimum-incision’ endoscopically assisted transvesical prostatectomy (MEATP) for managing benign prostatic obstruction secondary to a large (>80 g) prostate. Patients and methods In a prospective feasibility trial, 60 men with large benign prostates underwent MEATP. The baseline and postoperative evaluation included the International Prostate Symptom Score (IPSS), a measurement of maximum urinary flow rate (Qmax), and the postvoid residual (PVR) urine volume. The adenoma was enucleated digitally through a 3-cm suprapubic skin incision, and haemostasis was completed with endoscopic coagulation of the prostatic fossa. Perioperative complications were recorded and stratified according to the modified Clavien–Dindo score. Results The mean (SD, range) prostate weight estimated by ultrasonography was 102.9 (15.4, 80–160) g, the operative duration was 52 (8, 40–65) min, the haemoglobin loss was 2.1 (1, 0.4–5) g/dL, the catheterisation time was 5.2 (1.3, 4–9) days, and the hospital stay was 6.2 (1.4, 5–10) days. There were 21 complications recorded in 16 (27%) patients, and most (86%) were of grades 1 and 2. The most frequent complications were bleeding requiring a blood transfusion (8%), and prolonged drainage (5%). There was a significant improvement at 3 months after surgery in the IPSS (8.6 vs. 21.6, P < 0.001), Qmax (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001). Conclusion MEATP is feasible, safe and effective. Comparative studies and long-term data are required to determine its role in the surgical treatment of large-volume BPH. PMID:26019954

  10. Cerebellopontine angle epidermoid cysts: clinical presentations and surgical outcome.

    PubMed

    Hasegawa, Mitsuhiro; Nouri, Mohsen; Nagahisa, Shinya; Yoshida, Koichiro; Adachi, Kazuhide; Inamasu, Joji; Hirose, Yuichi; Fujisawa, Hironori

    2016-04-01

    Epidermoid cysts constitute less than 1 % of intracranial tumors with the majority of them involving cerebellopontine angle (CPA). Although several mechanisms for cranial nerve dysfunction due to these tumors have been proposed, no direct evaluation for hyper- or hypoactive dysfunction has been done. In this case series, pathophysiology of cranial nerve dysfunction in CPA epidermoid cysts was evaluated with special attention to a new mechanism of capsule strangulation caused by stratified tumor capsule. Twenty-two cases with epidermoid cysts of CPA micro-neurosurgically treated in our departments since 2005 were reviewed. Clinical status of the patients before the surgery and post-operative functional outcome were recorded. Available data from the English literature were summarized for comparison. Mass reduction of cyst contents in most cases was usually associated with prompt and marked improvement of the symptoms suggesting neuroapraxia caused by compression of the tumor content and/or mild ischemia. Among them, two cases showed strangulation of the affected nerves by the tumor capsule whose preoperative dysfunction did not improve after surgery in spite of meticulous microsurgical removal of the lesion. Involved facial and abducent nerves in these two cases showed distortion of nerve axis and nerve atrophy distal to the strangulation site. We report the first direct evidence of etiology of cranial nerve dysfunction caused by cerebellopontine angle epidermoid tumors. Young age and rapidly progressive neurological deficit might be the characteristics for strangulation of the affected nerves by the cyst capsule. Even though the number of cases might be limited, immediate decompression and release of the strangulating band might be urged in such patients to prevent irreversible deficits. PMID:26566990

  11. Surgical Outcomes of Newly Trained ShangRing Circumcision Providers

    PubMed Central

    Lee, Richard K.; Li, Philip S.; Zulu, Robert; Agot, Kawango; Combes, Stephanie; Simba, Raymond O.; Hart, Catherine; Lai, Jaim Jou; Zyambo, Zude; Goldstein, Marc; Feldblum, Paul J.; Barone, Mark A.

    2016-01-01

    Background: Devices can potentially accelerate scale-up of voluntary medical male circumcision in sub-Saharan Africa. Studies have demonstrated advantages of the ShangRing device over conventional circumcision. With the need to train providers rapidly for scale-up, concerns arise about the transferability of techniques and the expertise of new trainees. Methods: We compared outcomes of ShangRing circumcisions conducted in Kenya by experienced providers (experience with more than 100 ShangRing circumcisions) and newly trained providers (trained in Kenya by the experienced providers before the study began). During training, trainees performed at least 7 ShangRing circumcisions and 3 removals. Newly trained providers received intermittent clinical mentoring initially during the study but otherwise conducted circumcisions on their own. Results: Four hundred six and 115 ShangRing procedures were performed by the new trainees and the experienced providers, respectively. The mean duration of circumcisions was 6.2 minutes for both trained and experienced provider groups (P = 0.45), whereas the mean pain score (on an 11-point scale) was 2.5 and 3.2, respectively (P = 0.65). There was no difference in the proportion of participants healed by the day 42 visit (P = 0.13) nor in the incidence of moderate and severe adverse events observed (P = 0.16). Participants in both groups were equally satisfied with final wound cosmesis. Discussion: Results demonstrate that the ShangRing circumcision technique is easy to learn and master. Newly trained providers can safely conduct ShangRing circumcisions in routine service settings. The ShangRing can facilitate rapid rollout of voluntary medical male circumcision for HIV prevention in sub-Saharan Africa. PMID:27331584

  12. Surgical Management of Local Recurrences of Renal Cell Carcinoma

    PubMed Central

    Acar, Ömer; Şanlı, Öner

    2016-01-01

    Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients, surgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment. PMID:26925458

  13. Surgical Management of Local Recurrences of Renal Cell Carcinoma.

    PubMed

    Acar, Ömer; Şanlı, Öner

    2016-01-01

    Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients, surgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment. PMID:26925458

  14. A review of the surgical management of right-sided aortic arch aneurysms.

    PubMed

    Barr, James G; Sepehripour, Amir H; Jarral, Omar A; Tsipas, Pantelis; Kokotsakis, John; Kourliouros, Antonios; Athanasiou, Thanos

    2016-07-01

    Aneurysms and dissections of the right-sided aortic arch are rare and published data are limited to a few case reports and small series. The optimal treatment strategy of this entity and the challenges associated with their management are not yet fully investigated and conclusive. We performed a systematic review of the literature to identify all patients who underwent surgical or endovascular intervention for right aortic arch aneurysms or dissections. The search was limited to the articles published only in English. We focused on presentation and critically assessed different management strategies and outcomes. We identified 74 studies that reported 99 patients undergoing surgical or endovascular intervention for a right aortic arch aneurysm or dissection. The median age was 61 years. The commonest presenting symptoms were chest or back pain and dysphagia. Eighty-eight patients had an aberrant left subclavian artery with only 11 patients having the mirror image variant of a right aortic arch. The commonest pathology was aneurysm arising from a Kommerell's diverticulum occurring in over 50% of the patients. Twenty-eight patients had dissections, 19 of these were Type B and 9 were Type A. Eighty-one patients had elective operations while 18 had emergency procedures. Sixty-seven patients underwent surgical treatment, 20 patients had hybrid surgical and endovascular procedures and 12 had totally endovascular procedure. There were 5 deaths, 4 of which were in patients undergoing emergency surgery and none in the endovascular repair group. Aneurysms and dissections of a right-sided aortic arch are rare. Advances in endovascular treatment and hybrid surgical and endovascular management are making this rare pathology amenable to these approaches and may confer improved outcomes compared with conventional extensive repair techniques. PMID:27001673

  15. Surgical Management and Reconstruction of Hoffman's Disease (Dissecting Cellulitis of the Scalp).

    PubMed

    Hintze, Justin M; Howard, Brittany E; Donald, Carrlene B; Hayden, Richard E

    2016-01-01

    Dissecting cellulitis of the scalp, or Hoffman's disease, is a rare dermatologic condition characterized by recurrent pustules and sinus tract formation leading to scarring and alopecia. Medical management includes the use of corticosteroids, antibiotics, isotretinoin, and adalimumab. In cases where the disease is severe, refractory, and intractable, surgery is an option. We report two cases of Hoffman's disease, where medical management failed to achieve remission. Surgical treatment was undertaken with complete resection of the affected scalp in staged procedures with subsequent split-thickness skin grafting for reconstruction. Surgery achieved both disease remission and excellent aesthetic outcomes in both patients. PMID:26966606

  16. Surgical Management and Reconstruction of Hoffman's Disease (Dissecting Cellulitis of the Scalp)

    PubMed Central

    Hintze, Justin M.; Howard, Brittany E.; Donald, Carrlene B.; Hayden, Richard E.

    2016-01-01

    Dissecting cellulitis of the scalp, or Hoffman's disease, is a rare dermatologic condition characterized by recurrent pustules and sinus tract formation leading to scarring and alopecia. Medical management includes the use of corticosteroids, antibiotics, isotretinoin, and adalimumab. In cases where the disease is severe, refractory, and intractable, surgery is an option. We report two cases of Hoffman's disease, where medical management failed to achieve remission. Surgical treatment was undertaken with complete resection of the affected scalp in staged procedures with subsequent split-thickness skin grafting for reconstruction. Surgery achieved both disease remission and excellent aesthetic outcomes in both patients. PMID:26966606

  17. Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping

    PubMed Central

    Aoki, Takachika; Hirohata, Masaru; Noguchi, Kei; Komaki, Satoru; Orito, Kimihiko; Morioka, Motohiro

    2016-01-01

    Background: Treatment of anterior choroidal artery (AChA) aneurysms with endovascular coiling or surgical clipping may increase the risk of ischemic complications owing to the critical territory supplied by the AChA. We analyzed the surgical results of endovascular coiling and surgical clipping for AChA aneurysms performed in a single institution, as well as the role of indocyanine green-videoangiography (ICG-VAG) and motor-evoked potential (MEP). Methods: We analyzed 50 patients (51 aneurysms; 21 men, 29 women; mean age: 58 years) including 25 with subarachnoid hemorrhage treated with endovascular coiling or surgical clipping between April 1990 and October 2013. The complication rates and clinical outcomes of the coil group (mean follow-up: 61 months) and the clip group (mean follow-up: 121 months) were analyzed with a modified Rankin scale. Results: The overall clinical outcome of the coil group (95%) was better than that of the clip group (85%). Especially, the outcomes in the coil group were better in the first investigated period (1990–2007) (P < 0.05). However, after the introduction of ICG-VAG and MEP, the outcomes in the clip group improved significantly (P = 0.005), and treatment-related complications decreased from 20 to 4.7%. Eleven aneurysms (coil group: 8, clip group: 3) showed small neck remnants but no remarkable regrowth, except for 1 case during the mean follow-up period of 91 months. Conclusions: Surgical clipping of AChA aneurysms has become safer because of ICG-VAG and MEP monitoring. Coiling and clipping of AChA aneurysms showed good and comparable outcomes with these monitoring methods.

  18. Relationship between total quality management, critical paths, and outcomes management.

    PubMed

    Lynn, P A

    1996-09-01

    Total quality management (TQM), clinical paths, and outcomes management are high-profile strategies in today's health care environment. Each strategy is distinct, yet there are interrelationships among them. TQM supports a customer-focused organizational culture, providing tools and techniques to identify and solve problems. Clinical paths are tools for enhancing patient care coordination and for identifying system-wide and patient population specific issues. Outcomes management is an integrated system for measuring the results in patient populations over time. There is a recent shift in outcomes measurement towards expanding both the nature of the outcomes examined and the timeframes in which they are studied. PMID:8920370

  19. Surgical Management of Recurrent Musculotendinous Hamstring Injury in Professional Athletes

    PubMed Central

    Sonnery-Cottet, Bertrand; Daggett, Matt; Gardon, Roland; Pupim, Barbara; Clechet, Julien; Thaunat, Mathieu

    2015-01-01

    Background: Hamstring injury is the most common muscular lesion in athletes. The conservative treatment is well described, and surgical management is often indicated for proximal tendinous avulsions. To our knowledge, no surgical treatment has been proposed for failure of conservative treatment in musculotendinous hamstring lesions. Purpose: To describe the surgical management of proximal and distal hamstring musculotendinous junction lesions in professional athletes after failure of conservative treatment. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of 10 professional athletes, including 4 soccer players, 4 rugby players, and 2 handball players, underwent surgical intervention between October 2010 and June 2014 for the treatment of recurrent musculotendinous hamstring injuries. All athletes had failed at least 3 months of conservative treatment for a recurrent musculotendinous hamstring injury. Surgical resection of the musculotendinous scar tissue was performed using a longitudinal muscular suture. Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at the 3-month follow-up, and a final phone interview was completed to determine recurrence of hamstring injury and return to previous level of play. Results: The mean age at surgery was 25.2 years (range, 19-35 years). The musculotendinous hamstring lesions involved 8 semitendinosus and 2 biceps femoris, with 6 injuries located proximally and 4 distally. Conservative treatment lasted a mean 5.1 months (range, 3-9 months) after last recurrence, and the patients had an average of 2.7 (range, 2-5) separate incidents of injury recurrence before surgical intervention was decided upon. At the 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. All 10 patients returned to the same level of play at a mean 3.4 months (range, 2-5 months). At a mean follow-up of 28.7 months, none of the athletes had suffered a recurrence. No surgical

  20. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    PubMed Central

    Cloyd, Jordan M; George, Elizabeth; Visser, Brendan C

    2016-01-01

    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles. PMID:27022448

  1. [Prediction of outcomes of surgical treatment of degenerative lumbar disk disease].

    PubMed

    Zhuravlev, Iu I; Nazarenko, G I; Cherkashov, A M; Riazanov, V V; Nazarenko, A G

    2009-01-01

    The paper focuses on algorithms of outcomes assessment of surgical treatment of the patients with degenerative lumbar disk disease. From 1997 to 2006 389 patients with discogenic lumbar pain were operated in the Medical Center of Central Bank of Russia. 185 patients underwent radiofrequency destruction of facet nerves, laser percutaneous lumbar discectomy was performed in 39 patients, microdiscectomy -- in 131, and decompression combined with lumbar spine stabilization -- in 31 cases. Clinical and radiological data of each patient were recorded in the database using 3-point scale according to intensity of the feature. Assessment of patients' condition was performed pre- and postoperatively (after discharge and after 6, 12 and 24 months interval). Postoperative outcome was recorded for the current period in compliance with modified criteria of Kawabata et al. Obtained data were mathematically and statistically processed. Developed algorithms allowed assessment of postoperative outcome in the patients with degenerative lumbar disk disease. Outcome data can be used for evaluation of feasibility of surgical treatment as well as for selection of surgical technique. PMID:19505029

  2. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    PubMed Central

    Moscote-Salazar, Luis Rafael; M. Rubiano, Andres; Alvis-Miranda, Hernando Raphael; Calderon-Miranda, Willem; Alcala-Cerra, Gabriel; Blancas Rivera, Marco Antonio; Agrawal, Amit

    2016-01-01

    Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.  PMID:27162922

  3. Remote video management for intraoperative consultation and surgical telepresence.

    PubMed

    Boanca, Cosmin; Rafiq, Azhar; Tamariz, Francisco; Lavrentyev, Vladimir; Onisor, Daniel; Flerov, Evgeniy; Popescu, Irinel; Merrell, Ronald C

    2007-10-01

    Telemedicine applications can connect surgeons from one operating room (OR) to a distant consultant. The additional capacity of telepresence provides remote consultants the ability to control their own view of the surgical field using robotic management of a network camera. The goal of this study was to compare access to surgical field by robotic camera versus image controlled by the surgeon using a camera mounted to the table. A Stryker laparoscopic camera was attached to the OR table using a Mediflex arm, and video image was transmitted with a Polycom Transfer Control Protocol (TCP)/Internet Protocol (IP) connection. A network Sony camera was mounted on a tripod, connected over the Internet using a parallel TCP/IP connection. A Web interface allowed control of the camera angle and zoom. In 22 consultations effective bandwidth was 800 Kbps for the network camera and 1024 Kbps for the Stryker camera. The operation was thyroidectomy and the consultant was either in Moscow, Russia, or Bucharest, Romania. The quality of the image in both methods was indiscernible. The ability to identify critical surgical anatomy was also indiscernible. No transmission session failed or had an interruption. The robotic camera can be a powerful tool for surgical collaboration. PMID:17999622

  4. Surgical Management of Benign and Borderline Phyllodes Tumors of the Breast.

    PubMed

    Moutte, Amandine; Chopin, Nicolas; Faure, Christelle; Beurrier, Frédéric; Ho Quoc, Christophe; Guinaudeau, Florence; Treilleux, Isabelle; Carrabin, Nicolas

    2016-09-01

    Phyllodes tumors (PT) are uncommon fibroepithelial breast neoplasms and there is currently no clear consensual treatment for these tumors. The aim of our study was to evaluate the surgical management and outcome of benign and borderline PT. We retrospectively assessed 76 cases of benign or borderline PT managed at the Leon Berard comprehensive cancer center in Lyon, France between July 2003 and December 2013. The mean age at diagnosis was 37.9 years and the median follow-up was 58 months. Seventy-five patients (99%), with a mean tumor size of 27 mm, underwent a breast-conserving procedure. The tumor margins were considered positive (when the tumor was present at the inked surgical section) in seven of 76 cases (9%) and negative in 65 out of 76 cases (86%). We observed the presence of small negative surgical margins <10 mm in 89% and <1 mm in 71% of the patients. Although no re-excision was performed to increase these margins, we did not see any increase in the local recurrence rate (4%) when compared to recurrence rates reported in the literature. We thus suggest that systematic revision surgery for close or positive surgical margins for benign PT should not be systematically performed. However, as recurrences occur within 2 years of initial excision, we recommend a regular clinical and imaging follow-up especially during this period for which patient's compliance is essential. PMID:27265474

  5. Prediction of post-surgical seizure outcome in left mesial temporal lobe epilepsy☆

    PubMed Central

    Feis, Delia-Lisa; Schoene-Bake, Jan-Christoph; Elger, Christian; Wagner, Jan; Tittgemeyer, Marc; Weber, Bernd

    2013-01-01

    Mesial temporal lobe epilepsy is the most common type of focal epilepsy and in its course often becomes refractory to anticonvulsant pharmacotherapy. A resection of the mesial temporal lobe structures is a promising option in these cases. However, approximately 30% of all patients remain with persistent seizures after surgery. In other words, reliable criteria for patients' outcome prediction are absent. To address this limitation, we investigated pre-surgical brain morphology of patients with unilateral left mesial temporal lobe epilepsy who underwent a selective amygdalohippocampectomy. Using support vector classification, we aimed to predict the post-surgical seizure outcome of each patient based on the pre-surgical T1-weighted structural brain images. Due to morphological gender differences and the evidence that men and women differ in onset, prevalence and symptomology in most neurological diseases, we investigated male and female patients separately. Thus, we benefitted from the capability to validate the reliability of our method in two independent samples. Notably, we were able to accurately predict the individual patients' outcome in the male (94% balanced accuracy) as well as in the female (96% balanced accuracy) group. In the male cohort relatively larger white matter volumes in the favorable as compared to the non-favorable outcome group were identified bilaterally in the cingulum bundle, fronto-occipital fasciculus and both caudate nuclei, whereas the left inferior longitudinal fasciculus showed relatively larger white matter volume in the non-favorable group. While relatively larger white matter volumes in the female cohort in the left inferior and right middle longitudinal fasciculus were associated with the favorable outcome, relatively larger white matter volumes in the non-favorable outcome group were identified bilaterally in the superior longitudinal fasciculi I and II. Here, we observed a clear lateralization and distinction of structures

  6. Pain assessment and management in surgical nursing: a literature review.

    PubMed

    Bell, Liz; Duffy, Anita

    Although postoperative pain assessment and management is an integral part of surgical nursing practice, it remains ad hoc despite numerous costly empirical research studies. Patients have a right to pain relief; however, the barriers to assessing and managing patient pain in practice have not as yet been overcome. A literature review to establish the main barriers to effective postoperative pain relief in clinical practice was carried out. The findings suggest that time management, and attitudes and beliefs of both patients and nurses are significant factors hampering practice. The authors conclude that future research in this area is futile, and suggest that nurses should focus on auditing their own practice to improve the effectiveness of pain management in practice and enhance standards of care. PMID:19223798

  7. Ovarian Mature Cystic Teratoma: Challenges of Surgical Management

    PubMed Central

    Sinha, Abha; Ewies, Ayman A. A.

    2016-01-01

    Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases. PMID:27110246

  8. Surgical Outcomes in Patients with High Spinal Instability Neoplasm Score Secondary to Spinal Giant Cell Tumors

    PubMed Central

    Elder, Benjamin D.; Sankey, Eric W.; Goodwin, C. Rory; Kosztowski, Thomas A.; Lo, Sheng-Fu L.; Bydon, Ali; Wolinsky, Jean-Paul; Gokaslan, Ziya L.; Witham, Timothy F.; Sciubba, Daniel M.

    2015-01-01

    Study Design Retrospective review. Objective To describe the surgical outcomes in patients with high preoperative Spinal Instability Neoplastic Score (SINS) secondary to spinal giant cell tumors (GCT) and evaluate the impact of en bloc versus intralesional resection and preoperative embolization on postoperative outcomes. Methods A retrospective analysis was performed on 14 patients with GCTs of the spine who underwent surgical treatment prior to the use of denosumab. A univariate analysis was performed comparing the patient demographics, perioperative characteristics, and surgical outcomes between patients who underwent en bloc marginal (n = 6) compared with those who had intralesional (n = 8) resection. Results Six patients underwent en bloc resections and eight underwent intralesional resection. Preoperative embolization was performed in eight patients. All patients were alive at last follow-up, with a mean follow-up length of 43 months. Patients who underwent en bloc resection had longer average operative times (p = 0.0251), higher rates of early (p = 0.0182) and late (p = 0.0389) complications, and a higher rate of surgical revision (p = 0.0120). There was a 25% (2/8 patients) local recurrence rate for intralesional resection and a 0% (0/6 patients) local recurrence rate for en bloc resection (p = 0.0929). Conclusions Surgical excision of spinal GCTs causing significant instability, assessed by SINS, is associated with high intraoperative blood loss despite embolization and independent of resection method. En bloc resection requires a longer operative duration and is associated with a higher risk of complications when compared with intralesional resection. However, the increased morbidity associated with en bloc resection may be justified as it may minimize the risk of local recurrence. PMID:26835198

  9. [The industrial management and the management of surgical units].

    PubMed

    Chaabane, S; Guinet, A; Smolski, N; Guiraud, M; Luquet, B; Marcon, E; Viale, J-P

    2003-12-01

    Management of operating rooms is moving nowadays. Financial constraints as well as new operating practices prompt the hospital manager to optimise the operating room utilisation. The manufacturing systems faced a similar situation in the early 1980, due to the increase in the cost of the energetic products and the new competitive environment. Manufacturers had to improve dramatically their management capabilities in order to overcome their financial and technical difficulties. If the manufacturing management is extensively developed nowadays, the operating room is still running on an intuitive, individual and manual basis. The purpose of this review is to describe the main features of the manufacturing management and to identify those relevant to the management of operating rooms. PMID:14644375

  10. Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Assessment of Post-treatment Clinical Outcome

    PubMed Central

    ZOGOPOULOS, Panagiotis; NAKAMURA, Hajime; OZAKI, Tomohiko; ASAI, Katsunori; IMA, Hiroyuki; KIDANI, Tomoki; KADONO, Yoshinori; MURAKAMI, Tomoaki; FUJINAKA, Toshiyuki; YOSHIMINE, Toshiki

    2016-01-01

    Spinal dural arteriovenous fistulas (DAVFs) are the most commonly encountered vascular malformation of the spinal cord and a treatable cause of progressive para- or tetraplegia. It is an elusive pathology that tends to be under-diagnosed, due to lack of awareness among clinicians, and affects males more commonly than females, typically between the fifth and eighth decades. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality. The purpose of our retrospective, single-center study was to determine the long-term clinical and radiographic outcome of patients who have received endovascular or surgical treatment of a spinal DAVF. In particular, during a 6-year period (2009–2014) 14 patients with a spinal DAVF were treated at our department either surgically (n = 4) or endovascularly (n = 10) with detachable coils and/or glue. There was no recurrence in the follow-up period (mean: 36 months, range 3–60 months) after complete occlusion with the endovascular treatment (n = 9; 90%), while only one patient (10%) had residual flow both post-treatment and at 3-month follow-up. All four surgically treated patients (100%) had no signs of residual DAVF on follow-up magnetic resonance angiography (MRA) and/or angiography (mean follow-up period of 9 months). Since improvement or stabilization of symptoms may be seen even in patients with delayed diagnosis and substantial neurological deficits, either endovascular or surgical treatment is always justified. PMID:26466887