Sclerosing encapsulating peritonitis and methotrexate.
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Abortifacient Agents, Nonsteroidal↗
Biomedical subjects
V Usatoff
Publications and source records attributed to V Usatoff.
Operative treatment of pseudocysts in patients with chronic pancreatitis.
BACKGROUND: Pseudocysts associated with chronic pancreatitis are generally intrapancreatic and associated with parenchymal disease. They tend to persist and cause complications. Minimally invasive methods of treatment challenge the traditional techniques of operative management. Surgical operation allows definitive treatment of the pseudocyst with the option of dealing appropriately with the diseased pancreas and excluding a neoplastic process. The aim of this study was to review the safety and efficacy of a surgical approach to the management of pseudocysts associated with chronic pancreatitis. METHODS: A personal series of 112 consecutive patients operated for pseudocysts in the setting of chronic pancreatitis was reviewed. Chronic pancreatitis was confirmed by imaging studies in association with exocrine and/or endocrine failure. Cysts were multiple in 31 patients and presented with complications other than pain in 47. Data were collected prospectively regarding the clinical presentation, the nature of the operation and its outcome. RESULTS: Forty-eight patients (43 per cent) underwent drainage procedures, 56 (50 per cent) had a resection and eight (7 per cent) had a combination. Larger cysts and those located in the head and neck tended to be drained, while smaller and distal cysts were more often resected. The morbidity rate was 28 per cent and the operative mortality rate was 1 per cent. The cyst recurrence rate was 3 per cent and pain was relieved in 74 per cent of patients. CONCLUSION: Operative management of pseudocysts associated with chronic pancreatitis is effective with low morbidity and mortality rates. The introduction of newer minimally invasive techniques will have to withstand comparison to this traditional approach.
Adolescent↗
Hepatic malignancy: challenges and opportunities for the surgeon.
The management of hepatic malignancy has changed from a previously nihilistic approach to a more positive one. Every patient should be considered for curative surgical resection, either at first presentation or after cytoreductive treatment. The surgeon is faced with the challenge of adapting modern surgical techniques to increase resectability rates. Although the majority of patients are unsuitable for resection, effective palliation can be achieved using a wide variety of techniques. The rational implementation of these palliative modalities requires a multidisciplinary approach which provides the surgeon with the opportunity to play a key role in the ongoing management of these patients.
Algorithms↗
A lateral approach to the below-knee popliteal artery without resection of the fibula.
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Fibula↗
A critical evaluation of free paper abstracts accepted for the 1996 RACS Annual Scientific Congress.
BACKGROUND: Abstracts form a major part of medical information dissemination and a measure by which papers are accepted for meetings. Concerns have been raised about the quality of abstracts presented to the Annual Scientific Congress (ASC) and second, about the validity of the term 'scientific' to describe this meeting. METHODS: A critical evaluation was made of all free paper abstracts in general surgery from the ASC 1996, using a standard assessment process. They were judged on presentation and content. A direct comparison was made to the content of abstracts from the Surgical Research Society of Australasia 1995(SRSA) meeting. RESULTS: The ASC abstracts scored 87% (6.1/7.0) for presentation but with clear deficiencies. The score of 49% (7.4/15.0) for the content of the ASC abstracts was significantly less than the score of 65% (9.8/15.0) that was attained by the SRSA abstracts when assessed on content. (Wilcoxon rank sum test, P < 0.000002.) CONCLUSIONS: The quality of the presentation of abstracts was adequate but could clearly be improved, especially with regard to the specific instructions to authors. The ASC abstracts were significantly less scientific in content that those of the SRSA abstracts. The criteria used to select abstracts for the ASC should be reviewed and the title of the annual College meeting should be reconsidered.
Abstracting and Indexing↗
The longer term results of internal anal sphincterotomy for anal fissure.
This study details the results of a retrospective analysis of 98 patients who underwent lateral subcutaneous internal sphincterotomy for the treatment of fissure in ano. Data with particular emphasis on patient satisfaction and anorectal control were collected by postal questionnaire. Minimum follow up was 15 months with an average of 41 months. Ninety-seven per cent of patients indicated that they were moderately or very satisfied with the outcome of the procedure and 90% claimed symptomatic improvement with this being sustained in 69%. Eighteen per cent of patients noted ongoing new problems with minor impairment of anorectal control. Despite these symptoms, 90% of this group were also moderately or very pleased with the outcome and 72% had resolution of their symptoms which was sustained in more than two-thirds of cases. It is concluded that lateral subcutaneous internal sphincterotomy is well tolerated and the majority of patients are more than moderately pleased with the outcome. There was however a significant incidence of minor impairment in anorectal control but this did not detract from the perceived success of the procedure.
Adolescent↗
Resection of hepatocellular carcinoma.
The majority of hepatocellular carcinoma occurs in patients with liver cirrhosis. Although the tumors are often discovered at an early stage during surveillance of these patients, the underlying cirrhosis renders the surgery more difficult and exposes the patients to higher rates of postoperative morbidity and mortality than occurs in other types of liver surgery. Over the past 20 years surgeons have developed new surgical procedures and techniques to firstly reduce the unnecessary resection of liver parenchyma and to decrease intraoperative blood loss. Better patient selection and understanding of prognostic factors will hopefully result in a further decrease in operative risk and postoperative recurrence. Adjuvant chemotherapy may prove effective in reducing the postoperative recurrence but at this stage surgery still remains as the best treatment for patients with recurrent tumor which is accessible to resection.
Carcinoma, Hepatocellular↗
Liver resection in advanced hepatocellular carcinoma.
BACKGROUND/AIMS: The aim of this study was to assess the results of major liver resection in patients with advanced hepatocellular carcinoma in terms of safety and survival. METHODOLOGY: The subjects of this study are 19 patients that underwent 24 resections for advanced (stage IV) hepatocellular carcinoma. Eighteen of these resections were performed for primary tumor and 6 were repeat resections. Nine patients presented without cirrhosis, 5 with cirrhosis, and 5 patients had the fibrolamellar variant of hepatocellular carcinoma. RESULTS: Hospital mortality was recorded in 1 case (5%). Morbidity was noted in 7(37%) cases. All patients with fibrolamellar variant of hepatocellular carcinoma are alive at 78, 41, 24, 12 and 9 months (P = 0.008), compared with a median survival of 18 and 9 months for the noncirrhotic hepatocellular carcinoma and cirrhotic hepatocellular carcinoma groups, respectively (P = 0.24). CONCLUSIONS: We conclude that an aggressive policy of major liver resection with vascular reconstruction was justifiable in patients with advanced fibrolamellar variant of hepatocellular carcinoma and in selected patients with noncirrhotic hepatocellular carcinoma, and of doubtful value in patients with cirrhosis.
Carcinoma, Hepatocellular↗
Surgery for cholangiocarcinoma.
Cholangiocarcinoma is a cancer arising from bile duct epithelium and commonly occurs in the main bile duct or at the bile duct confluence. The patients present obstructive jaundice and often have advanced disease. Treatment in the past has frequently consisted of palliative measures aimed at relieving jaundice either by surgical bypass or by endoscopic or percutaneous drainage usually in combination with stenting. A better understanding of the ways of invasion of the pathology of cholangiocarcinoma together with improvements in surgical techniques and perioperative management have lead to an increase in the number of patients in whom resection may be contemplated. Resection offers the only chance of cure and the best chance of long-term survival. Current problems associated with resection of hilar cholangiocarcinoma are discussed in this review article.
Bile Duct Neoplasms↗
Update of laser-induced thermotherapy for liver tumors.
Surgical resection generally offers the only chance of long-term survival for patients with primary or secondary liver tumors. Difficulties relating to the stage of the tumor, the extent of underlying liver cirrhosis and the general condition of the patient make this technique unsuitable for the majority of patients. Many nonresectional methods of in-situ tumor ablation have been recently described. These include alcohol injection, cryotherapy, radiofrequency and intraoperative radiotherapy. Recently more interest has been directed to the use of laser as a source of ablative energy. Laser-induced interstitial thermotherapy is an experimental technique used to destroy tumors within the liver. Initially this was in the form of bare-tipped photocoagulation but the development of a diffuser tip has enabled the formation of larger diameter lesions using heat to produce an area of coagulative necrosis. Less heat is lost if hepatic vascular inflow is occluded during the procedure and consequently a larger area of tumor necrosis is produced. The prospect of a simpler, more efficient system of tumor ablation is attractive so we undertook a review of the current issues surrounding this emerging treatment.
Colorectal Neoplasms↗