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PubMedDate not supplied

Management of malignant mucinous adenomas.

BACKGROUND: Malignant polyps are defined as adenoma with cancerous tissue penetrating into or through the muscolaris mucosae in the submucosa, and endoscopic removal is the most common treatment for such polyps. In the presence of malignant mucinous adenoma, defined as a malignant adenoma in which a significant amount of mucus is present in the stroma, the therapeutic approach is controversial and authors have performed surgical resection in all cases. The purpose of the study was to demonstrate that malignant mucinous adenoma is not a condition suggesting by itself a bowel resection. METHODS: Ten patients with malignant mucinous adenoma were enrolled in the study: endoscopic treatment alone was performed in 4 cases, and polypectomy was followed by surgical resection in 6 cases. RESULTS: At a median follow-up of 74.2 months no distant metastases had occurred in any of the patients treated with endoscopic polypectomy alone; during the follow-up, 1 patient had a local recurrence and surgical resection was performed. Only one case of residual disease was found at histology among the patients in which endoscopic polypectomy was followed by surgical resection. No complications occurred after endoscopic treatment in any case. CONCLUSIONS: In the absence of unfavorable histologic parameters, malignant mucinous adenomas should be managed with the same criteria of other malignant adenomas, and endoscopic polypectomy is considered as a safe and effective treatment when radicality criteria are fulfilled.

Adenoma↗

PubMed1998

Functional outcome after posterolateral spinal fusion using pedicle screws: comparison between primary and salvage procedure.

Lumbar spinal fusion is a commonly performed surgical procedure, yet both the indications for its performance and its results remain controversial. It is generally believed that apart from situations where obvious measurable instability exists, a repeat surgical procedure such as spinal fusion does not improve the functional outcome in more than an average of 50% of cases. The aim of this study was to analyse functional outcome after posterolateral lumbar or lumbosacral spinal fusion, comparing primary and salvage procedures. It was designed as a prospective case/referent study with a 2-year follow-up. A total of 39 patients underwent a short posterior fusion with Cotrel-Dubousset (CD) pedicle screw fixation after earlier surgery of the lumbar spine. Two patients were erroneously omitted from the study at the index, so 37 patients were included in the salvage group. In the same period, 69 patients underwent lumbar fusion with pedicle screw fixation (CD) as primary surgery (referent group). Functional outcome was assessed by means of the Dallas Pain Questionnaire preoperatively and 1 and 2 years postoperatively. Fusion rates were determined by ordinary X-ray evaluation by two independent observers. Patients who had undergone previous spinal surgery had a significant improvement in functional outcome in terms of daily activity, work and leisure-time activities and anxiety/depression. With regard to social functioning, a significantly inferior outcome was found after the salvage procedure. The return-to-work rates at 2 years after surgery were 50% in the salvage group and 53% in the referent group. There was a significant correlation between radiological evaluation of the fusion mass and the functional outcome. The fusion rate was 76% in the salvage group and 72% in the referent group. This study demonstrates that a posterolateral spinal fusion can be effectively used as a salvage procedure. The functional and radiological outcome of the patients with revision surgery did not differ from those of the group of patients who underwent primary surgery. There was, however a clear indication of inferior social functioning after revision surgery.

Adult↗

PubMed2001

[Surgical procedure of gynecologic malignances in patients over 70 years].

OBJECTIVE: To assess the viability of performing surgical procedure on gynecologic malignances patients over 70 years old. METHODS: A retrospective study of all patients 70 years of age and older treated by surgical procedure for gynecologic malignances was performed between September 1, 1983, and June 30, 1999. RESULTS: Fifty-seven patients were older than 70 years of age at the time of the diagnosis. Mean age of the patients was 73.5 years. In thirty-four patients a extensive surgical procedure was carried out, while in twenty-three patients a conservative surgery was done. Seventy-one percent of patients had one or more preexisting medical illnesses. Minor surgical morbidity occurred in 31.6% of the patients, while major surgical morbidity occurred in 10.5% of the patients. There were no differences in the type of surgical procedure, mean hospital stay, preexisting medical illness and postoperative complication between patients 70 to 75 and over age 75. The total major postoperative complications occurred in extensive surgical procedure group and postoperative mean stay was also significantly length. CONCLUSIONS: The extensive surgical procedure is a safe treatment for elderly patients with gynecologic malignances. Careful preoperative assessment, monitoring, and meticulous postoperative care are vital to the success.

Aged↗

PubMed1998

Our treatment of cleft lip and cleft palate.

Our principle in cleft lip and cleft palate repair is all-round personal treatment. That is, treatment concentrates not only on cleft lip and cleft palate repair, but also considers the patient comprehensively in terms of his or her personality. In this report, we present patients with cleft lips and/or cleft palates for whom we performed surgical treatments in the past 25 years. We performed primary operations for 402 patients and secondary operations for 120. Cleft lip and cleft palate should be managed with consideration for otolaryngeal aspects as well as plastic surgical ones because of the nature of the disease. We therefore treated our patients from the standpoints of both medical fields, and gained much appreciation from parents whose children suffered from the congenital anomaly.

Child↗

PubMed1984

Identification of patients with improved survival following coronary bypass surgery.

This study was designed to determine whether left ventricular performance measured noninvasively from the systolic time intervals could identify patients in whom coronary bypass surgery may improve survival. 71 patients with two- or three-vessel disease undergoing coronary bypass surgery were compared with 78 matched medically treated patients. All patients had recuperated from myocardial infarction by a mean of 17.6 months when systolic time intervals were performed. Surgical and medical patients were classified preoperatively into those with normal and those with abnormal left ventricular performance by preejection period/left ventricular ejection time (PEP/LVET less than or equal to 0.42 and greater than 0.42, respectively). Survival was analyzed by life table and log-rank test. Cumulative 5-year survival in patients with normal left ventricular performance was not statistically different in surgical and medical groups (96 vs. 93%, respectively). In contrast, cumulative survival in patients with abnormal left ventricular performance was significantly greater in the surgical group when compared to the medical group (84 vs. 62, p less than 0.01). Among the patients with abnormal left ventricular function, the mean PEP/LVET and the average vessel disease were not different in the medical and surgical groups. Multivariate analysis of 17 other clinical and laboratory risk variables were not different between these two groups. It is concluded that coronary bypass surgery my improve survival in patients with two- or three-vessel disease and left ventricular dysfunction.

Actuarial Analysis↗

PubMed1991

Prognostic value of surgical and postoperative findings in cattle with abomasal volvulus.

A prospective study evaluating the prognostic value of surgical and postoperative findings in 80 cattle with abomasal volvulus was performed. Surgical correction of abomasal volvulus was performed in all animals. After surgery, cattle were categorized into 3 groups: productive (acceptable milk production or appetite, n = 59), salvaged (poor milk production or appetite, n = 10), and nonsurvivors (n = 11). Cattle with omasal-abomasal volvulus had a significantly (P less than 0.005) worse prognosis than cattle without omasal involvement. Large abomasal fluid volume, venous thrombosis, and blue or black abomasal color before decompression were all indicative of a poor prognosis. Most cattle had poor or fair appetites the first day after surgery; productive animals had marked improvement in appetite over the next 3 days. All cattle observed to have a good appetite within 3 days after surgery were later determined to be productive animals. The heart rate decreased in all groups after surgery; however, tachycardia (heart rate greater than 80 beats/min) was sustained in cattle that were later salvaged for slaughter. Diarrhea was observed after surgery in 54% of cattle. The duration of diarrhea was significantly shorter (P = 0.009) in productive cattle than in salvaged and nonsurviving cattle. The presence or absence of diarrhea was only of predictive value when considered in conjunction with the estimated abomasal fluid volume.

Abomasum↗

PubMed1995

Carpal tunnel syndrome: update.

Since reports in the late 1940s of surgical treatment for compressive neuropathy of the median nerve at the wrist, carpal tunnel release has become one of the most commonly performed surgical procedures. Despite the frequency of this surgery, controversy remains regarding diagnosis and management. Fifty consecutive surgically treated cases performed under local anesthesia. Ninety percent of patients (45/50) obtained complete relief of symptoms. The success rate is related to proper patient selection and complete division of the transverse carpal ligament under direct vision at surgery.

Adult↗

PubMed1998

Manual vs robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks.

OBJECTIVE: To compare the surgical performance of manual and robotically assisted laparoscopic instruments on basic maneuvers and intracorporeal suturing in inanimate models. DESIGN: A set of laparoscopic tasks was used to evaluate basic endoscopic movements and intracorporeal suturing: positioning a cylinder on a Peg-Board, dropping beads into receptacles, running a 25-cm rope, and capping a hypodermic needle. Intracorporeal knot tying and running a suture through predetermined points were evaluated separately. The sutures used for these tasks were 2-0 and 4-0 silk and 6-0 and 7-0 polypropylene. PARTICIPANTS: Twenty surgeons completed the set of laparoscopic tasks manually and then with a robotically assisted system. None had used the robotic system before. MAIN OUTCOME MEASURES: Time required to complete the tasks and the precision in performing them. RESULTS: The robotic system accurately reproduced the movements of the surgeons and filtered their hand tremors efficiently. In the basic tasks, operative times were significantly longer for the robotic system (P<.001). In the suturing tasks, operative times were longer with the use of the robotic system for sutures sizes 2-0 and 4-0 (P<.001). However, time differences were not significant for suture sizes 6-0 and 7-0 (P> or =.07). Precision measurements were similar for all tasks using the manual instruments and the robotically assisted system. No significant differences were found between the performance of advanced laparoscopic surgeons and laparoscopic fellows. CONCLUSIONS: Laparoscopic maneuvering and suturing is faster and just as precise when performed manually as when performed with the prototype robotic system. These differences in speed are inversely proportional to the size of the suture. Future generations of the robotic system may eliminate these differences.

Equipment Design↗

PubMed1993

[Surgical treatment of endocardial cushion defect in 3 elderly patients].

We performed surgical treatment for partial endocardial cushion defect in 3 patients over fifty year old. Case 1 was a 55-year-old-male with TR of grade II. Case 2 was a 59-year-old-female with TR and MR, and was repaired mitral cleft by a mattress suture. She needed infusion of dopamine (over 5 micrograms/kg/min) for 6 days and therapy of mediastinitis postoperatively. Case 3 was 56-year-old-male without atrioventricular valve regurgitation. Preoperative left ventricular volume was small in all patients, therefore perioperative circulatory control, mainly water balance, and respiratory control were importance. All patients survived, and both decreasing of CTR and improvement of NYHA classification were recognized in all three patients. In conclusion the operation for ECD in even elder patients was effective, but intensive care needed perioperatively.

Endocardial Cushion Defects↗

PubMed2003

How aggressive should we be in patients with stage IV colorectal cancer?

PURPOSE: The prognosis for metastatic colorectal cancer is grave. Whether to perform surgical resection or palliative treatment remains controversial for this advanced disease. In this retrospective study, we collected data from patients with Stage IV colorectal cancer to identify prognostic factors for predicting selection criteria for surgical treatment in patients with metastatic disease. METHODS: A retrospective chart review was performed for patients treated from 1992 to 1999 from the Koo Foundation Sun Yat-Sen Cancer Center Tumor Registry. Seventy-four patients were identified as having Stage IV disease at the time of diagnosis. Data concerning the patients' demographics, laboratory results, operative procedure, mortality, morbidity, and survival were collected. Independent variables and survival time were analyzed by the independent t-test method. The difference was considered statistically significant at P < 0.05. RESULTS: Overall survival time for the patients with Stage IV colorectal cancer was 16.1 months. Survival in the curative resection group was significantly longer than that in the noncurative group (31.9 vs. 12.7; P < 0.016). The operative mortality and morbidity rates were 5.6 percent (4 of 71) and 21.1 percent (15 of 71), respectively. The two most common complications were leakage at the site of anastomosis and urinary tract infection. Based on these results, we conclude that patients older than 65 years, with metastases at multiple sites, intestinal obstruction, preoperative carcinoembryonic antigen level > or =500 ng/ml, lactate dehydrogenase > or =350 units/liter, hemoglobin <10 mg/dl, or hepatic parenchymal replacement by tumor >25 percent have poor prognosis for surgical intervention. CONCLUSION: Whether to perform primary tumor resection in patients with asymptomatic Stage IV colorectal cancer remains controversial; however, the more aggressively we perform radical resection and metastasectomy to selected patients, the more survival benefits the patients obtain.

Adult↗

PubMed1999

Emerging technologies for surgery in the 21st century.

Laparoscopic surgery is a transition technology that marked the beginning of the information age revolution for surgery. Telepresence surgery, robotics, tele-education, and telementoring are the next step in the revolution. Using computer-aided systems such as robotics and image-guided surgery, the next generation of surgical systems will be more sophisticated and will permit surgeons to perform surgical procedures beyond the current limitations of human performance, especially at the microscale or on moving organs. More fundamentally, there will be an increased reliance on 3-dimensional images of the patient, gathered by computed tomography, magnetic resonance imaging, ultrasound, or other scanning techniques, to integrate the entire spectrum of surgical care from diagnosis to preoperative planning to intraoperative navigation to education through simulation. By working through the computer-generated image, first with preoperative planning and then during telepresence or image-guided procedures, new approaches to surgery will be discovered. These technologies are complemented by new educational opportunities, such as tele-education, surgical simulation, and a Web-based curriculum. Telementoring will permit further extension of the educational process directly into the operating room.

Forecasting↗

PubMed2000

Surgical repair of the pulmonary trunk aneurysm.

OBJECTIVE: Aneurysm formation of the pulmonary trunk is rare and there is controversy about optimal treatment for this disease. The aim of this article is to report four patients with pulmonary trunk aneurysm which were managed by surgical repair. MATERIALS AND METHODS: From 1986 to 1997, we performed surgical repair for pulmonary trunk aneurysm in four patients. There was one male and three female patients with a mean age of 63.3 years (range: 54-78 years). Concomitant diseases were cardiac valvular disease in four patients, thoracic aortic dissection in two, atherosclerotic abdominal aortic aneurysm in two, and coronary artery disease in one. All patients were in New York Heart Association functional class III preoperatively. Surgical procedures for the pulmonary trunk aneurysm included Dacron graft replacement in two patients and aneurysmorrhaphy in two. Associated procedures were cardiac valvular operation in three patients with four lesions and right ventricular outflow tract reconstruction (RVOTR) in one. RESULTS: There were no operative mortalities and no late deaths with a mean follow-up period of 6.6 years (range: 2.4-10.0 years). One female patient developed recurrent pulmonary trunk aneurysm 9.5 years after aneurysmorrhaphy, and underwent a second operation where Dacron graft replacement of the aneurysm including pulmonary valve replacement was performed successfully. All patients are now leading normal lives. CONCLUSIONS: Surgical management should be considered for large aneurysm of the pulmonary trunk regardless of its etiology and underlying disease to prevent possible rupture with fatal result if the patient has an acceptably low operative risk.

Aged↗

PubMed2000

Benchmarking method relies on data snapshots.

This surgical performance measurement methodology takes a data 'snapshots' of peer facilities. Data are collected within the same time window. Reports compare participants with similar surgical facilities. Top performers' methods are shared with all participants in the interest of sharing proven quality techniques.

Benchmarking↗

PubMed1999

Preferred route of tracheostomy--percutaneous versus open at the bedside: a randomized, prospective study in the surgical intensive care unit.

Percutaneous tracheostomy has been touted as the preferred route of tracheostomy. However, to date, no prospective randomized study comparing bedside percutaneous (BP) to bedside open (BO) tracheostomy has been performed. Surgical intensive care unit (sICU) patients were randomized to receive either a BP or a BO tracheostomy. Patients were monitored for complications. Procedure time was documented. A group of medical ICU patients had open tracheostomies in the operating room (OR) and served as contemporaneous controls. Over 11 months, there were 24 surgical ICU patients randomized to receive either BP tracheostomy or BO tracheostomy, 12 in each group. Forty-six medical ICU patients received standard open tracheostomy in the OR. The number of ventilator days before placing the tracheostomy was similar between the BP and BO groups, 9.8 and 12.4, respectively. The clinical indications for tracheostomy were similar between the two groups. The procedure time for the BP group was 14.5 minutes, whereas 25.2 minutes for the BO group. There were no postprocedure complications in the BP and BO groups. There was a trend toward more complications in the BP group, including the loss of the airway, leading to death. The procedure time and complications were similar between the BO and OR groups. These data do not support that BP tracheostomy is the preferred route of tracheostomy when compared with BO tracheostomy. These data support that experienced surgical intensivists can perform BO tracheostomies with lower risk and cost, when compared with BP tracheostomy.

Adult↗

PubMed2000

Surgery for dural arteriovenous fistula in superior sagittal sinus and transverse sigmoid sinus.

The aim of this study was to evaluate the outcome of surgically treated dural arteriovenous fistula (DAVF). The authors performed surgical removal of DAVF in 12 patients. The locations of DAVF were the transverse sigmoid sinus in seven patients and superior sagittal sinus in five patients. These 12 patients had undergone endovascular embolisation prior to removal. Among them, six patients were completely cured, according to angiography immediately after embolisation, but these six patients showed the recurrence of DAVF within 1 year. The other six patients showed a decrease of feeding vessels. Therefore, all 12 patients underwent surgical removal of DAVF. The surgical strategies were as follows. The feeding vessels and the cortical veins with retrograde filling were occluded and cut. The affected sinus was skeletonised, and if it was occluded or almost occluded, the sinus was removed. Postoperatively, transient aphasia was seen in one patient. There was no surgical morbidity or mortality. During the follow-up period (mean 2.9 years), no recurrence of DAVF was seen. Surgical treatment is a safe and effective treatment manoeuvre for DAVF around the transverse sigmoid sinus and superior sagittal sinus.

Adult↗

PubMed1994

Photorefractive keratectomy for low myopia at 5 mm treatment diameter. A comparison of two excimer lasers.

The aim of the study was to evaluate the algorithm and surgical performance of two excimer lasers, the Summit Excimed 200 LA and the VISX 20/20, by assessing visual outcome parameters such as visual acuity and contrast sensitivity, and subjectively estimating dark vision performance. Furthermore, refractive results and centration of the surgically ablated area were assessed. Twenty patients were included in each group. The indications were myopia between -2 to -5 diopters allowing up to -0.75 diopters astigmatism. The treatment diameter was 5 mm. The postoperative treatment was topical dexamethasone for 3 months. The follow-up time was 12 months. The results showed a median refraction +/- 0.0 D in the Summit group and -0.5 D in the VISX group 12 months postoperatively. The uncorrected visual acuity was 0.5 (20/40) or better for 100% of the Summit treated eyes, whereas 85% of the VISX treated eyes achieved 0.5 (20/40) or better. The other visual qualities as contrast sensitivity, dark vision and centration of the ablation zone were the same in both groups. The slightly more myopic outcome of the VISX laser explains the poorer average uncorrected visual acuity in this group. We have, as a result of the refractive results, changed our algorithm in the VISX machine to achieve emmetropia. It is our experience that one should try to reach emmetropia in this young population.

Adult↗

PubMed2000

Medical abortion and the potential for new abortion providers: a cautionary tale.

The prochoice movement has expressed much hope that medical abortion will increase the pool of abortion providers because it does not require surgical training and does not need to be performed in specialized settings. By offering a detailed case study of the events surrounding a methotrexate abortion in a rural community health center by a family practice physician who had not previously performed surgical abortion, this article suggests that the diffusion of medical abortion to new providers and new settings may be more complex than some have suggested. The article illustrates that abortion is not only a medical procedure, but also a social process involving relations with large, often unfriendly bureaucracies as well as with the local community in which the abortion takes place. While still retaining optimism that medical abortion will ultimately increase the number of providers and hence increase access to abortion, the author believes that such a change will be considerably more gradual than commonly thought.

Abortifacient Agents, Nonsteroidal↗

PubMed1991

[Kidney adenoma].

Morphological, electron microscopic, histospectrophotometric and morphometric (mean nuclear surface and ellipticity coefficient) studies of small cortical adenomas were performed. Surgical (kidneys removed because of renal cell carcinoma and shrinkage) and autopsy (atrophic kidney) materials were used. Total 142 adenomas were found in 93 out of 592 observations. The incidence of adenomas in kidneys with renal cell carcinoma was 12%, in contracted kidneys 19.2 and 19.44% (surgical and autopsy material). Electron microscopic examination was performed in 15 adenoma cases. Comparative quantitative DNA determination was performed in sections stained by Feulgen using plug-method on the microscope spectrum analyzers in 20 cases of adenoma and 15 cases of renal cell carcinoma identical histologically to adenocarcinoma. This combined study revealed the adenomas heterogeneity. Only part of them (well differentiated with diploid DNA-histograms and nuclei up to 32 mm2 may be referred to adenomas. All the others morphologically and morphometrically are close to adenocarcinomas. The type of DNA distribution and mean nuclear surface are most important for differential diagnosis between renal adenoma and carcinoma.

Adenoma↗