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PubMed1994

Comparison of Adhesion Formation in Open Wedge Resection (OWR) With Microsurgical Wedge Resection (MWR)

In 21 patients with polycystic ovarian disease, a laparotomy ovarian wedge resection was performed on both ovaries. The vessels were coagulated with a mini-bipolar instrument. Then, randomly one ovary was left open and the other closed with Vicryl material (5-0 in the interior and 8-0 on the edge of the ovary). Six weeks later, during a second look laparoscopy, the ovaries were scored according to adhesion formation (AFS classification). The mean score of adhesion in the two groups was 52/21 MWR and 82/21 OWR. The mean and standard error for the differences of scores were 1.43 and 0.94, respectively, which were not significant. Contrary to the previous report (Am J Obstet Gynecol; 163:1674, 1990), our study in humans does not show that the OWR is superior to MWR.

Journal Article↗
PubMed2006

Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases.

No previous reports on lymph-node metastasis (LNM) from superficial squamous cell carcinoma of the esophagus have proposed definite criteria for additional treatment after endoscopic mucosal resection (EMR). We investigated the association between histopathological factors and LNM in 464 consecutive patients with superficial squamous cell carcinoma of the esophagus who had undergone a radical esophagectomy with lymph-node dissection (14 'M1' lesions: intraepithelial tumors, 36 'M2' lesions: tumors invading the lamina propria, 50 'M3' lesions: tumors in contact with or invading the muscularis mucosa, 32 'SM1' lesions: tumors invading the most superficial 1/3 of the submucosa and 332 'SM2/3' lesions: tumors invading deeper than SM1 level). Histopathological factors including invasion depth, size, lymphatic invasion (LY), venous invasion, tumor differentiation, growth pattern, degree of nuclear atypia and histological grade were assessed for their association with LNM in 82 M3 or SM1 lesions to determine which patients need additional treatment after EMR. LNM was found in 0.0, 5.6, 18.0, 53.1 and 53.9% of the M1, M2, M3, SM1 and SM2/3 lesions, respectively. A univariate analysis showed that each of the following histopathological factors had a significant influence on LNM: invasion depth (M3 vs SM1), LY, venous invasion and histological grade. Invasion depth and LY were significantly associated with LNM in a multivariate analysis. Four out of 38 patients (10.3%) with M3 lesions without LY had LNM, whereas five out of 12 patients (41.7%) with M3 lesions and LY had LNM. Only patients with M1/2 lesions are good candidates for EMR. Invading the muscularis mucosa (M3) is a high-risk condition for LNM the same as submucosal invasion, but M3 lesions without LY can be followed up after EMR without any additional treatment.

Adult↗
PubMed2001

A systematic review of intravesical bacillus Calmette-Guérin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancer.

OBJECTIVE: To assess, in a systematic review, the effectiveness of intravesical bacillus Calmette-Guérin (BCG) in preventing tumour recurrence in patients with medium/high risk Ta and T1 bladder cancer. PATIENTS AND METHODS: An electronic database search of Medline, Embase, DARE, the Cochrane Library, Cancerlit, Healthstar and BIDS was undertaken, plus hand searching of the Proceedings of ASCO, for randomized controlled trials, in any language, comparing transurethral resection (TUR) alone with TUR followed by intravesical BCG in patients with Ta and T1 bladder cancer. RESULTS: The search identified 26 publications comparing TUR with TUR + BCG. Six trials were considered acceptable, representing 585 eligible patients, 281 in the TUR-alone group and 304 in the TUR + BCG group. The major clinical outcome chosen was tumour recurrence. The weighted mean log hazard ratio for the first recurrence, taken across all six trials, was -0.83 (95% confidence interval -0.57 to -1.08, P < 0.001), which is equivalent to a 56% reduction in the hazard, attributable to BCG. The Peto odds ratio for patients recurring at 12 months was 0.3 (95% confidence interval of 0.21-0.43, P < 0.001), significantly favouring BCG therapy. Manageable toxicities associated with intravesical BCG were cystitis (67%), haematuria (23%), fever (25%) and urinary frequency (71%). No BCG-induced deaths were reported. CONCLUSION: TUR with intravesical BCG provides a significantly better prophylaxis of tumour recurrence in Ta and T1 bladder cancer than TUR alone. Randomized trials are still needed to address the issues of BCG strain, dose and schedule, and to better quantify the effect on progression to invasive disease.

Administration, Intravesical↗
PubMed2001

Lifting of lesions during endoscopic mucosal resection (EMR) of early colorectal cancer: implications for the assessment of resectability.

BACKGROUND AND STUDY AIMS: This study assessed the indications for and limitations of endoscopic mucosal resection (EMR) for early colorectal cancer, focusing on the way in which the lesion lifts after submucosal injection. PATIENTS AND METHODS: The study included 94 patients with early colorectal cancer who received EMR treatment. The lifting of the lesion after submucosal injection was analyzed (classified as completely lifted/soft; completely lifted/hard; incompletely lifted; and non-lifted) along with the endoscopic findings, pathological findings, and clinical course. RESULTS: Almost all completely lifted/soft lesions were mucosal cancers. Some of the completely lifted/hard lesions were staged as sm2. The incompletely lifted lesions included stages sm1 to sm3. Non-lifting lesions were almost always deeper than sm3. The lifting condition was significantly associated with the depth of invasion, and the lesion type was related to the extent of lifting but not to tumor size or recurrent disease. Recurrent disease was noted in three patients who underwent piecemeal EMR. CONCLUSIONS: The indication for EMR is easily assessed on the basis of the lifting characteristics of the tumor after submucosal injection, which was found to be significantly related to the depth of invasion. The factor limiting the indication for EMR is not the size of a tumor, but its lifting condition.

Aged↗
PubMed1999

Histopathologic studies of colorectal postendoscopic resection sites: "skipping electrothermal injury" associated with endoscopic resection procedures.

To elucidate the pathologic changes due to endoscopic resection (ER), 32 post-ER sites in 24 surgically removed colorectal specimens and the previous ER specimens were examined. The depth of all the previous ER specimens was restricted to the submucosa, and all post-ER sites showed submucosal stromal changes of various degrees. Fourteen sites (43.8%) showed muscular or serosal changes. One of these lesions was considered to be a reaction to a tattoo agent, but all the other lesions were considered to represent skipping electrothermal injury caused by electrical current passing through the colorectal wall. The lesions consisted of muscular depletion in the inner layer of the muscularis propria (12 sites, 37.5%), hemorrhage or fibrosis between the inner and outer layers of the muscularis propria (3 sites, 9.4%), and serosal changes (10 sites, 31.3%). These skip regions would be vulnerable to electrical current. These findings suggest that asymptomatic electrothermal injury associated with ER is frequent. Statistically, the electrothermal injury appeared to be related to the size of the previous ER specimens. However. these results also reveal that the ER of tissues <10 mm can cause electrothermal injury and can result in full-thickness necrosis.

Aged↗
PubMed1991

The importance of near total resection of the corpus spongiosum and total resection of the corpora cavernosa in the surgery of male to female transsexuals.

From 1980 to 1989, 13 male to female transsexuals underwent surgery for resection of the corpus spongiosum, performed at the Department of Plastic and Reconstructive Surgery of the Free University Academic Hospital, Amsterdam, The Netherlands. Except for 1, all patients underwent the primary sex-reassignment procedures in institutions other than this hospital. All had difficulties during sexual activities. After repeat surgery with near complete excision of the corpus spongiosum and also in three instances of the corpus cavernosum, improvement was noticed in all patients. The importance of the total elimination of the erectile tissue is emphasized.

Adult↗
PubMed2006

Comparison of transurethral resection and plasmakinetic transurethral resection applications with regard to fluid absorption amounts in benign prostate hyperplasia.

INTRODUCTION: We compare the absorption of irrigant fluid during gyrus plasmakinetic transurethral prostatectomy (PK-TURP) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: 42 patients with clinical benign prostatic hyperplasia were randomly assigned to undergo PK-TURP or TURP. In the PK-TURP group 0.9% NaCl was used as an irrigation fluid and 1.5% glycine in the TURP group. By adding ethanol to the irrigation fluids 1% ethanol-containing solutions were formed. All operations were carried out under spinal anesthesia and alcohol concentration of the ventilated air measurements were made just at the beginning of the operation, every 10 min peroperatively and at the end of the operation by using an alcoholmeter. RESULTS: There was no difference in age, prostate volume and the length of operation time in either group. In both groups, the estimated absorbed fluid volume increased with the duration of surgery (p < 0.05). The difference between mean fluid absorption during PK-TURP and during TURP was the statistically significant (p < 0.01). CONCLUSION: PK-TURP operation causes lesser absorption of the irrigation fluid than the TURP operation. The lesser absorption of irrigation fluid and using saline instead of glycine decreases the risk of TUR syndrome.

Absorption↗
PubMedDate not supplied

Intravenous procaine as a supplement to general anesthesia for carbon dioxide laser resection for carbon dioxide laser resection of laryngeal papillomas in children.

Procaine suppresses the cough reflex, decreases laryngeal irritability, and has general anesthetic properties. For these reasons, 14 pediatric patients undergoing CO2 laser resection of laryngeal papillomas were studied in which an intravenous infusion of procaine (1 mg/kg/min) was added to N2O-O2 halothane/enflurane general anesthesia immediately following endotracheal intubation. These patients were compared to nine patients receiving the same anesthesia without procaine. The mean age of both groups was 11 years. There was no difference between the groups in duration of anesthesia or surgery. Emergence, however, averaged 15 minutes in study patients compared to 36 minutes in the control group (p less than 0.01). There was no difference in anesthetic concentrations required to maintain satisfactory operative conditions in the two groups. Muscle relaxants were required intraoperatively in seven control patients but in none of the study patients. The surgeon ranked the operative conditions excellent in all study patients but poor in seven of the nine control patients. Five of the latter required postoperative treatment of laryngeal complications, including reintubation in three. Only one of the study patients had postoperative stridor. No evidence of procaine toxicity was noted in the study patients with total doses ranging from 500--3600 mg. Intravenous procaine is useful in pediatric patients having endoscopic laryngeal operations.

Anesthesia, Inhalation↗
PubMedDate not supplied

Adrenocortical carcinoma: a 15-year survival after complete resection and repeated resection. A retrospective study in a patient with an expected poor prognosis.

Adrenocortical carcinoma is a rare but aggressive malignancy with metastases being present in 30-40% of cases at the time of diagnosis. A number of prognostic factors have been identified in patients with adrenocortical carcinoma, but criteria predicting survival are not uniform. We report the case of a 58-year-old man with a large, non-functioning and poorly-differentiated adrenocortical carcinoma who, according to current knowledge, was expected to have a short survival. On the contrary, the prompt diagnosis and curative resection of the primary tumour, together with two reoperations for local recurrences, allowed a 15-year survival and a good quality of life. A revision of both clinical and histological prognostic factors is therefore needed in patients with this type of malignancy.

Adrenal Cortex Neoplasms↗
PubMed1992

[Prospective randomized trial comparing modified FAM (5-fluorouracil (5-FU) + adriamycin + mitomycin C) versus 5-FU alone for the treatment of non-resectable pancreatic and biliary tract carcinomas (the 1st trial in non-resectable patients). Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract].

The modified FAM (5-fluorouracil (5-FU) + adriamycin (ADR) + mitomycin C (MMC)) therapy (FAM group) was compared with 5-FU mono-therapy (F group) by multi-institutional randomized trial in the patients with cancer of the pancreas or the biliary tract who underwent non-resection. The patients in FAM group received 6 mg/m2 of i.v. MMC during operation, 310 mg/m2 of i.v. 5-FU for 5 days in the 1st and 3rd postoperative weeks and 12 mg/m2 of i.v. ADR in the 2nd postoperative week. Those in F group received only 5-FU course in the administration schedule of FAM group. Among the cases which completed respective whole administration schedules. 35 cases in FAM group and 36 in F group, better effect than partial response (PR) was observed in neither groups, and there was no significant difference between groups with respect to overall/each disease survival duration, progression-suppressed duration and clinical effect. Primary adverse effects were alimentary symptoms and hepatic dysfunction, neither of which was serious, and there was no difference between groups except that hair loss was observed in more cases in FAM group (p less than 0.05). Results in FAM group did not statistically surpass those in F group, but a tendency was observed that FAM group was better than F group in terms of survival duration and clinical effect for cancer of the gall-bladder.

Adult↗
PubMed2004

[Enlarged translabyrinthine resection of recurrent acoustic neuroma after suboccipital resection].

OBJECTIVE: To evaluate the technique and the outcome of enlarged translabyrinthine removal of recurrent acoustic neuromas after a suboccipital resection. METHOD: Five patients were proved to have recurrent acoustic neuromas after previous suboccipital removal procedures. Revision surgery was accomplished in these patients using the enlarged translabyrinthine approach by sufficiently removing petrous temporal bone to enlarge exposed sight during the operation. RESULT: The sizes of the recurrent tumors ranged from 2.5 to 4.0 cm. Total removal was achieved in all patients, with no death and other major complications such as intracranial infection and cerebrospinal fluid leakage. The facial nerve function was the same as pre-operative condition. There was no residual tumor showed in CT scans and MRI examinations after operation. The cerebel and brainstem resumed to normal position in each patient. No second recurrences had occurred to date at follow-up of 6 months to 2 years and 7 months. All patients recuperated and came back to work. CONCLUSION: Acoustic neuroma recurs frequently after the suboccipital surgery because there is a residual tumor inside the internal acoustic canal (IAC). The enlarged translabyrinthine approach is the most direct access to acoustic neuroma and the brainstem by which recurrent tumor can be removed is avoided during the second operation. Moreover, it is praisable that there are several advantages such as slight invasion and convenience of facial nerve orientation so as to excellent outcome of facial nerve preservation in the enlarged translabyrinthine surgery.

Aged↗
PubMedDate not supplied

[Emergency surgery for neoplastic left colon obstruction: resection and primary anastomosis (RPA) versus Hartmann resection (HR)].

UNLABELLED: This retrospective study compares: hospitalization time, morbidity and mortality (patients operated for neoplastic occlusion of the left colon in emergency, without perforation), considering hanestesiologic risk and surgical technique (RPA versus RH). MATERIALS AND METHODS: From April 1999 to February 2003 the Emergency Surgery of AORN of Caserta has operated, in urgency, 60 neoplastic patients with left colon occlusion realizing: 46 (76.5%) RPA [36 ASA < or = III, low hanestesiologic risk (LAR), 10 ASA = or > IV high hanestesiologic risk (HAR)], 12 (20%) RH (2 LAR and 10 HAR) 2 (3.5%) palliative colostomics. RESULTS: 36 LAR patients with RPA had 5% of specific complications and 5% of medical complications. 2 LAR patients with R-H: no complication. 10 HAR patient with RPA brought 10% of specific complications and 10% of medical complications. 10 HAR patients with RH had 20% of specific complications and 10% of general complications. The middle hospitalization of LAR patients with RPA was 11 days versus 9 days of RH pz. (equal hanestesiologic risk ). The HAR pz., treated with RPA, had as middle hospitalization 15 ggs in comparison to the 9 ggs of the HRA pz. treated with RH. MORTALITY: 1/36 for LAR pz. with RPA (3%), and 0/0 for LAR pz. with RH; 1/10 for HAR pz, with RPA (10%) and 1/10 for HAR pz. with RH (10%). CONCLUSIONS: Resection and primary anastomosis, (correct indications and expert surgeon), gives prevalence of complications and mortality similar to the repeated surgical procedure, a better life quality, but an higher number of post-operating hospitalisation days.

Adult↗
PubMed1990

[Postoperative course following stomach resection: a comparison of Billroth I, Billroth II and Roux-en-Y resection-reconstruction].

53 patients who underwent gastric resection and reconstruction either by Roux-en-Y gastro-jejunostomy, Billroth I or Billroth II operation, were followed for an average of three years and compared for clinical status using the Visick grading system, dumping grading by the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Response to a standardized questionnaire and objective grading showed that our results for individual operations compared well with others reports. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I, and especially Billroth II, reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach, provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Anastomosis, Roux-en-Y↗
PubMed1990

[Results of treatment of superficial vesical tumors by transurethral resection alone and transurethral resection followed by an intravesical instillation of Calmette-Guerin bacillus].

Superficial bladder tumors treated at the Henri Mondor Hospital from 1984 through 1988 were analyzed for recurrence and progression using the following prognostic parameters: stage (TNM classification, 1978), grade (G1, G2, G3), size, number of tumors, and tumor malignancy index as defined by the Besançon group. Forty-five patients were treated with transurethral resection alone (TUR group) whereas 30 had TUR followed by the prophylactic instillation of fresh Calmette-Guérin bacillus in the bladder (BCG group). In TUR patients, parameters predictive of progression included grade G3, multiple tumors, stage T1, recurrence within 6 months of TUR, and a tumor malignancy index above 455. None of these criteria were predictive of a response to BCG. Results obtained in the BCG group were comparable to those reported in the literature and confirmed the efficacy of BCG instillations to prevent recurrence and progression of superficial carcinomas of the bladder.

Administration, Intravesical↗
PubMed1986

Indications and technique for endoscopic laser resections in bronchology. A critical analysis based upon 2,284 resections.

Over a period of 6 years, we have treated 1,310 patients in 2,284 sessions using a neodymium-yttrium aluminum garnet laser. Indications are more often palliative than curative, with the primary goal to relieve an obstructed airway in a single treatment. The effectiveness of such resections is widely recognized, but indications for such a technique with its limitations deserve emphasis. The use of a rigid bronchoscope is important to provide satisfactory operating conditions and especially to manage hemorrhage rapidly while maintaining a satisfactory airway.

Adolescent↗
PubMed1987

[Heart dislocation following extensive lung resection with partial pericardial resection].

Cardiac herniation is a rare but dramatic complication of pulmonary resection that demands urgent treatment. About 50 patients have been reported in the literature; 50% of them died. Symptoms vary depending on the location of the pericardial defect. Cardiac output falls, central venous pressure rises, and cyanosis develops that does not respond to oxygen administration. Right-sided herniation is characterized primarily by decreased blood pressure and tachycardia due to kinking or torsion of both superior and inferior venae cavae and subsequent reduction of cardiac filling. Left-sided herniation more often produces ischemic ECG changes and dysrhythmias due to jamming of the ventricles between the edges of the pericardial defect. Without intervention irreversible myocardial damage may rapidly result. Luxation typically arises at the end of the operation or in the early postoperative period. Precipitating factors are suction on the chest tube, changes in the patient's positioning, positive pressure ventilation to expand the remaining lung segments, coughing and extubation. In right-sided luxation an anteroposterior chest X-ray will substantiate the diagnosis without difficulty; in left-sided luxation the chest film may not show a similarly striking finding. Often dramatic deterioration in the patient's status may not allow time for diagnostic procedures. In case of doubt, immediate rethoracotomy is indicated. In the case observed, a 47-year-old woman underwent right pleuropneumonectomy with partial pericardectomy and intrapericardial ligation of the pulmonary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1985

[Benign tumors and mandibular resection. The place of resection grafts in the treatment of benign tumors of the mandible].

Data were analyzed from case-reports of 80 patients undergoing resection graft procedures for benign mandibular tumors, and operated upon and followed up in the Stomatology and maxillo-facial surgical Unit, Hospital Salpêtrière, Paris from 1970 to 1984. In 27 cases surgery was by first intention; in the others it followed one or several previous operations, their multiplicity sensibly affecting the decision to operate and the development of postoperative suppurations.

Adolescent↗