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PubMed1984

The effect of malignant epithelial tumors, surgical therapy, and bacterial sepsis upon various parameters of interferon system.

The influence of tumor load, surgical trauma, and bacterial sepsis upon the ability of patient's peripheral leukocytes to produce interferon-alpha (IFN-alpha), the detectable serum IFN levels and circulating serum IFN inactivators were studied. Peripheral blood leukocytes of patients with solid tumors had significantly reduced ability to produce IFN-alpha. Complete resectional surgery resulted in restoration of their ability to produce normal IFN-alpha levels. Circulating IFN levels were detectable in 70% of patients with localized disease while only in 20% of patients with metastatic disease. Interferon-alpha activators were detected in 45% of all patients. Both circulating interferon and IFN-alpha inactivators became undetectable upon tumor resection. Surgical trauma is accompanied by a transient but definite decrease in IFN-alpha production capability. Bacterial sepsis during postoperative days, in patients who successfully recovered, was definitely accompanied by increase in IFN-alpha production capability. Our findings suggest that advanced malignant epithelial tumors have an adverse effect upon the patient's ability to produce interferon and are often accompanied by the presence of circulating serum interferon inactivators. These effects can be reversed by surgical resection of the malignant neoplasm.

Adult↗
PubMed1996

Clinically accessible cell signaling: second messengers in sepsis and trauma.

Inflammatory mediators of trauma and sepsis transduce cellular events through cell surface receptors initiating intricate membrane and cytosolic reaction cascades that funnel through surprisingly few checkpoints in order to provoke a cellular response. As critical care surgeons, we can explore these cell signalling systems. The purpose of this article is to delineate the six known second messenger pathways relevant to surgical sepsis and trauma. Our comprehension of these signaling systems may offer us an opportunity to blunt post-traumatic cellular injury and promote a constructive response.

Animals↗
PubMed1991

Surgical treatment of nesidioblastosis in childhood.

A review of the literature on the surgical treatment of nesidioblastosis in childhood was made to answer the following questions: age at operation, surgical procedure, pathohistological findings, incidence of recurrence and its treatment, as well as mortality. Primary subtotal pancreatectomy appears to be the method of choice. It should be performed as early as possible following exact diagnosis. Total pancreatectomy is reserved for treatment of a recurrence.

Humans↗
PubMed1993

Epiphyseal stapling for leg equalization in developing countries.

Epiphyseal stapling to arrest growth in the longer limb in growing children has been used in 923 cases over 26 years in the management of leg length inequality. Five hundred and three were assessed at the end of growth. Seventy-one percent had 0.5 cm to 1 cm of shortening and 80% did not need an orthosis. Although other methods are available, this technique is particularly valuable in developing countries because it needs only basic surgical facilities and the financial cost is low.

Adolescent↗
PubMed1998

Principal modifications of the Duhamel procedure in the treatment of Hirschsprung's disease. Analysis based on results of an international retrospective study of 2,430 patients.

In the literature, many articles refer to the DUHAMEL technique or some of its modifications in the treatment of Hirschsprung's disease, however, no complete review of all of them has been published to date. The authors present an analysis of the principal modifications of this technique based on the results of an international retrospective survey that evaluated a series of 2,430 patients as well as data from the literature. The important role of the internal anal sphincter in the physiology of continence is emphasized; understanding its function is an imperative prerequisite for a successful Duhamel procedure. The original technique, which used two crushing Kocher clamps as proposed by Duhamel in 1956, as well as a majority of the modifications with various spur-crushing instruments are no longer in use. At present, surgeons generally use staplers for the colorectal anastomosis.

Anastomosis, Surgical↗
PubMed2001

Classification and surgical treatment of incisional hernia. Results of an experts' meeting.

BACKGROUND: The treatment of incisional hernia (IH) is a current problem in modern surgery. Many important aspects of incisional hernia surgery are yet to be answered, especially the choice of surgical technique and its adaptation to the individual patient. The aim of this experts' meeting was to resolve some current questions in incisional hernia surgery and to organise an international hernia register. METHODS: An international panel of ten experts met under the auspices of the European Hernia Society (GREPA) to investigate the classification and therapeutic alternatives for incisional hernia. Prior to the conference, all experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The information from this correspondence was used as a basis for panel discussion. The personal experiences of the participants and other aspects of individualised therapy were also considered. RESULTS: The expert panel suggested a new classification of incisional hernia based on localisation, size, recurrences and symptoms. All experts agreed that the fascia duplication and the fascia adaptation should only be used for small incisional hernias. Fascia duplication is of value only in the horizontal direction. The technical details and the pros and cons of each procedure were discussed for prosthetic implantation using onlay and sublay techniques and the technique of autodermal hernioplasty. CONCLUSIONS: The management of incisional hernia is currently not standardised. In order to answer relevant questions of incisional hernia surgery, an international hernia register should be established.

Hernia, Ventral↗
PubMed2004

Vacuum-assisted closure therapy: a new treatment option for recurrent pilonidal sinus disease. Report of three cases.

No single treatment option available for symptomatic pilonidal disease is entirely satisfactory. In our department, we have treated successfully three cases of pilonidal disease with vacuum-assisted closure therapy. We describe our initial experience with this technique. In two cases, the pilonidal sinus was primarily excised, a split skin graft applied to cover the defect, and the vacuum-assisted closure pump applied over the skin graft for a period of four days on a continuous negative pressure of 50 mmHg. The third case was treated and completely healed with vacuum-assisted closure therapy alone. To our knowledge, this is the first report in the literature describing the use of vacuum-assisted closure therapy for this condition. We propose this therapy as an alternative adjunctive treatment for pilonidal disease.

Adult↗
PubMed2004

Stapled hemorrhoidectomy with local anesthesia can be performed safely and cost-efficiently.

PURPOSE: This prospective study was designed to assess the feasibility of performing the procedure for prolapsing hemorrhoids, or stapled hemorrhoidectomy, under local anesthesia supplemented with conscious sedation. METHODS: Seventy consecutive patients (mean age, 56 years; 37 males) with Grade 3 or 4 hemorrhoids underwent the procedure for prolapsing hemorrhoids after perianal infiltration of 0.5 percent lidocaine with 1:200,000 epinephrine and supplemental conscious sedation. The procedure was performed in an outpatient setting, with the patient being discharged within two hours of checking into the ambulatory facility. All patients were assessed the following day by telephone, and then in the office at three weeks and two months for degree of postoperative pain, bleeding, continence, and time back to work or social activities. Additionally, all excised mucosal anastomotic rings were analyzed for presence or absence of muscle. RESULTS: Each patient rated the pain as minimal or none. Five patients complained of mild, transient perineal pressure, and three complained of fecal urgency and seepage before their first office visit; one complained of external skin tags at the second office visit. All subjects were back to work or social activities within three to four days-most within 48 hours. Complications included urinary retention in five patients, two of whom had a concomitant urinary tract infection, and one had urosepsis requiring hospitalization. One patient required immediate reoperation for bleeding from the staple line. Another patient was admitted for postoperative bleeding and packed with a hemostatic agent the evening of surgery. Muscularis propria fibers were identified in 68 of 70 pathologic specimens. CONCLUSIONS: Administration of general, spinal, or epidural anesthesia for the procedure for prolapsing hemorrhoids is well described. This study suggests that the use of local anesthesia supplemented with conscious sedation for the procedure for prolapsing hemorrhoids yields results equivalent to those achieved with general or regional anesthesia without the attendant risks and additional costs. This study also suggests that the presence of muscle fibers in the pathologic specimen does not seem to lead to increased pain or impaired continence, although it was not specifically designed to address this issue.

Ambulatory Surgical Procedures↗