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At least 649 records · Page 36Linked to original sources
PubMed1994

[Therapy of hypopharyngeal carcinoma. Part V: Discussion of long-term results of transoral laser microsurgery of hypopharyngeal carcinoma].

The results of transoral laser microsurgery of hypopharyngeal carcinomas have been described in previous publications. These are discussed on the basis of literature reports on the therapy used, inclusive of surgery and/or radiotherapy and/or chemotherapy. The most important parameters of prognosis include neck and distant metastases as well as multiple tumors. In analysing results of laser therapy, prognosis has been better compared to conventional types of therapy regarding loco-regional control and survival rates. Surgical overtreatment in the sense of pseudoradicality, especially when sacrificing parts of the larynx not involved by tumor, is compared to precision surgery employing the operative microscope and the laser. The latter, presupposing the necessary experience and complying with certain precautions, offers high oncological safety in resection of the primary tumor while at the same time preserving functionally important organic structures. The difficulties arising from a comparative assessment of therapeutic results are dealt with in detail. In terms of radiobiology, radiotherapy is generally given early (after about 2 weeks) in regions well supplied with blood and has been found to be very effective. Local immunologic factors concluding minimally-invasive surgery in the neck) can also be responsible for a favorable clinical course of disease, as can psycho-oncological aspects (quick functional rehabilitation as well as reintegration into job and family). The generally accepted, but probably outdated, guidelines for conventional head and neck surgery demanding extremely radical surgery of primary tumors, block resections, etc. must be critically revised.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Microsurgery of the nose and paranasal sinuses; concept, technique and result].

1. The close relationship between an impaired nasal air passage or chronic diseases of the paranasal sinuses and the bronchial system seems to be generally accepted. 2. Any improvement of the nasal respiration and chronic infections of the sinuses obviously have a positive effect on pathologic lung function, bronchitis and asthma. Even though a causal connection between the treatment of the chronic nasal and paranasal infection and the decrease of pulmonary symptoms in chronic bronchitis and asthma could not be verified yet by valuable statistics, the transnasal surgery reduces heavy nasal symptoms in more that 90% of our cases. 3. We consider endonasal microsurgery to be the safest and most convenient technique in the treatment of chronic nasal and paranasal diseases. This minimal invasive surgery therefore is suitable as well for the treatment of recurrent diseases which unfortunately cannot be avoided in this area.

Desoxycorticosterone↗
PubMed1993

[Initial experience with transanal endoscopic microsurgery].

The authors present their initial experience with transanal endoscopic microsurgery which they introduced as the first department in the Republic. So far they used the method in 10 patients. The purpose of the present paper is to provide information on the surgical approach to adenomas and carcinomas in the area of the rectum by a new surgical technique.

Adenoma↗
PubMed1993

[Bone and cartilage allografts in microsurgery of the ear].

The authors present there experience with bone allografts and costal cartilage allografts in middle ear microsurgery. A drastic selection of the doners and a careful preparation of the grafts avoid the risk of viral transmission to the receiver. The easy available materials can be used for reconstructing the ear drum, the ossicular chain and the tympanic bony wall. With good anatomical and functional results, even at long-term (3 and 4 years).

Bone Transplantation↗
PubMed1993

[Microsurgery of retinal detachment in children].

We conducted a retrospective study of 84 retinal detachments in 69 consecutive children under 15 years of age, operated using microsurgical techniques. The goal of this study was to evaluate the prognosis following this surgical approach. Trauma was the most frequent etiology (34.6% of eyes), followed by high myopia (31% of eyes). The other etiologies were varied. Cicatricial retinopathy of prematurity was the most common of them (9.5% of eyes). The series was characterised by the severity of retinal detachment at initial presentation with total retinal detachment in 44% of eyes, detached macula in 70.3% of eyes and severe PVR in 29.8% of eyes. Sixty nine of the 84 eyes were operated on. Thirty two eyes were managed using transscleral microsurgery and 37 eyes (53.6%) required vitrectomy. Permanent retinal reattachment was achieved in 51 of the 69 eyes (73.9%). The present series of retinal detachments in children was highly heterogeneous. Retinal detachments related to retinogenic retinal breaks (atrophic holes and oral dialyses) were more common compared with adult retinal detachments. Their prognosis after surgery was excellent. In contrast traction retinal detachments and detachments related to vitreogenic retinal tears were characterised by a more guarded prognosis. However microsurgical techniques have made the most severe cases, such as grade D2-D3 PVR, giant tears with an inverted posterior flap and detachments after penetrating eye injuries, amenable to surgical management with encouraging results.

Adolescent↗
PubMedDate not supplied

[The application of the sample recognition theory for a system of surgical diagnosis in microsurgery].

The paper outlines the applicability of the sample recognition theory to process the data obtained with the use of multifiber optical catheters as part of information systems for diagnostics and visualization for microsurgery. A specific example of synthesizing the image assessment algorithm by employing the sample recognition theory is considered for the visualization system for a laser angioplastic unit.

Algorithms↗
PubMed1995

[Transanal endoscopic microsurgery for local excision of rectal neoplasms].

We removed 30 benign, sessile, rectal polyps by the transanal approach between January 1990 and April 1994. In 16 patients we used transanal endoscopic microsurgery (TEM), while in 14 the adenoma was removed by submucosal excision (SE). There were 3 local recurrences in the SE group, but none as yet in the TEM group. There was no operative mortality. Early complications included myocardial infarction in 1 patient and persistent postoperative fever which responded to antibiotic treatment in another. Late complications included temporary, anal mucous leakage in 10% and 5% of the TEM and SE groups, respectively. TEM was found to be efficient for the removal of polyps in the upper and middle thirds of the rectum, and SE for those in the lower third. This enables safe removal of rectal polyps, avoiding the need for complex operations involving greater risks.

Adenomatous Polyps↗
PubMed1996

Current status of periodontal microsurgery.

Periodontal microsurgery has proven to be an effective means of improving the predictability of gingival transplantation procedures used in treating recession. It also promises to make papillary reconstruction a realistic possibility in the hands of most periodontists. The use of microsurgical principles and techniques has been extended to flap reflection and suturing as an ideal means of having precise control of the gingiva without traumatizing the tissue by stretching, distorting, or tearing it. Microsurgical use requires training and practice using visual feedback rather than tactile feedback as is common in macrosurgery. It is an area of great interest and practical application for the growth and future of periodontics.

Gingiva↗
PubMed1996

Transanal endoscopic microsurgery--initial experience from three centres in the United Kingdom.

Over a 28-month period, 100 transanal endoscopic microsurgical excisions of rectal tumours were carried out in three centres. The histological diagnosis was benign adenoma in 77 and invasive adenocarcinoma in 23. Complete excision of the tumour with histological confirmation was achieved in 70 (91 per cent) of the adenomas and in all but one of the carcinomas. Of the carcinomas, 18 were recognized before operation and the remaining five were diagnosed on postoperative histology. Of the patients with carcinoma, one had immediate further surgery, nine had radiotherapy and 13 had no extra treatment. To date, four patients have had a recurrence of villous adenoma, and two of the patients treated for invasive carcinoma have had local recurrence. These initial results of transanal endoscopic microsurgery in the UK compare well with those of earlier reports, indicating that the technique has a useful place in the management of sessile adenomas of the mid and upper third of the rectum, and of some carefully selected carcinomas.

Adenocarcinoma↗
PubMed1996

Prospective study of the proctographic and functional consequences of transanal endoscopic microsurgery.

A prospective study of clinical, manometric and proctographic results in 36 patients presenting for transanal endoscopic microsurgery was performed. Anorectal manometry showed no difference in maximal squeeze pressure before and 12 months after operation, but resting pressures were lower after surgery (mean(s.e.m.) preoperative 86.1(27.6) mmHg versus postoperative 67.2(23.2) mmHg, P < 0.05). The rectoanal inhibitory reflex was lost in a significant group of patients (reflex present in 34 of 36 patients before operation and in 27 of 36 12 months after operation, P < 0.05). Proctography, manometry and questionnaire showed preserved function of most modalities 12 months after operation such that if objective function was impaired clinical function was adequate.

Adult↗
PubMed1977

[Microsurgery of the temporal bone (author's transl)].

Microsurgery of the temporal bone has opened a new frontier in otology, neurosurgery and head and neck surgery. The operative approaches used to reach the most hidden supra-, retro-, infra- and premeatal regions of the temporal bone are described and their surgical uses are illustrated. Particular attention has been paid to the subtotal petrosectomy with permanent anterior transposition of the facial nerve and is indicated for the extirpation of large infra- and premeatal tumors as well as for the repair of sub- and infratemporal aneurysms of the internal carotid artery.

Aneurysm↗
PubMed1996

[10 years experiences with transanal endoscopic microsurgery. Histopathologic and clinical analysis].

The clinical and long-term results encountered from July 1983 to December 1992 are subject of this study. Contrary to other (transanal and transabdominal) surgical treatments the endorectal system permits therapeutic local excisions of large, rectal adenomas and early rectal carcinomas of the "low-risk" type within the entire rectum with minimal morbidity. A superior or comparable rate of adenoma recurrence (4.8%, n = 228) as well as a more favourable operative result (complication rate 3.9%; lethality 0.6%; n = 348) can be achieved with the transanal endoscopic microsurgery. Under palliative conditions, transanal endoscopic surgery is more effective than other conservative treatments in cases of circumscribed, non-stenotic carcinomas of the rectum. Thorough surgical training is required in order to successfully practice transanal endoscopic surgery.

Adult↗
PubMed1996

[Therapeutic effectiveness of combined microsurgery and radiosurgery in a patient with a huge trigeminal neurinoma].

A case of right trigeminal neurinoma extending from the cavernous sinus to the cerebellopontine angle in a 48-year-old male is reported. The patient first noticed right facial numbness in June 1993. Six months later, he experienced headaches with occasional nausea, diplopia, ataxic gait, tinnitus and dysphagia and was referred to our department on January 21, 1994. Neurological examination on admission showed multiple cranial nerve palsy from the 4th to 11th nerve on the right, and the cerebellar sign on the right. Initial CT and MRI revealed a large mass lesion extending from the right cavernous sinus to the right cerebellopontine angle. On February 16, 1994, radical resection of the tumor, except the lesion invading the cavernous sinus, was performed via a combined retroauricular and preauricular transpetrosal transtentorial approach. The histological diagnosis was neurinoma. The patient's postoperative course was uneventful and there was good clinical improvement, although the right facial numbness and mild diplopia persisted. On April 6, 1994, radiosurgery was performed with a maximum dose of 28 Gy and a marginal dose to 14 Gy to the remaining cavernous sinus lesion. Two weeks after radiosurgery, the patient achieved a complete return to his daily routine. Two-year follow-up CT and MRI showed a small residual les on in the right cavernous sinus alone. There was no evidence of tumor growth. No new neurological deficits had developed, and the patient's the double vision had resolved. Thus, the patient has been able to maintain a satisfactory level of activities of daily living. We wound like to emphasize the clinical value of the strategy used to treat this patient which combined microsurgery with subsequent radiosurgery.

Cranial Nerve Neoplasms↗
PubMed1977

Models and techniques for microsurgery research.

Microsurgery is used today to salvage severed parts and to reconstruct previous damage. Much remains to be learned in this field and laboratory research will direct future developments. Laboratory experience prior to clinical use is mandatory and takes several months of conscientious application. Various rat models are useful. Rat hind leg replantation and muscle autotransplantation provide experience in microdissection and vascular anastomoses with unequivocal end points. Finally, clinical cases have to be well chosen and meticulously planned.

Amputation, Traumatic↗
PubMed1996

MESA and TESE: experiences of the German section of urological microsurgery.

The introduction of microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) has enlarged the therapeutic options for irreparable azoospermia. After standardization of the indications and surgical procedure, the German section for urological microsurgery combined the data of all groups performing assisted reproduction. The indication for MESA or TESE is given in cases of congenital aplasia of the vas deferens, irreparable obstruction of the reproductive tract, failure after refertilization, in combination with tubulovasostomy for subsequent cryopreservation and for conservatively untreatable ejaculatory disturbances. Until October 1995, 87 couples were treated by MESA and conventional IVF; the embryo transfer rate (ET) was 4.6%, the pregnancy rate 1.1%. One child (1.1%) was born. 179 couples were treated by MESA and ICSI, the ET was 68.2%, the pregnancy rate 18.4%, and 11 children (6.1%) were born. TESE in combination with ICSI was performed in 65 cases, the ET was 84.6%, the pregnancy rate 23.1% and 6 children (9.2%) were born. Modern technological developments in reproductive medicine and increasing experience in andrological surgery have stabilized the position of interdisciplinary therapeutic concepts for the treatment of infertile couples.

Cell Separation↗
PubMed1996

[Evaluation of the usefulness of the laryngeal mask for general anesthesia in eye microsurgery--preliminary results].

PURPOSE: This prospective study was designed to compare intraocular pressure changes and haemodynamic response to insertion of either a laryngeal mask or an orotracheal tube during general anaesthesia for cataract surgery. MATERIAL AND METHODS: The effect of techniques (tracheal tube-TT, laryngeal mask airway-LMA) securing a clear upper airway on the heart rate changes (HR), arterial pressure (SAP, DAP), oxygen saturation (SpO2), end-tidal carbon-dioxide pressure (Et-CO2), intraocular pressure (IOP) and the incidence of coughing, stridor and sore throat was analysed in 60 patients undergoing cataract surgery during general anaesthesia. RESULTS: The mean values for HR, SAP, DAP and IOP measured before and after induction of anaesthesia were not different in both groups. After securing a clear airway, mean HR increased in TT group to 95.5/min and decreased to 75.7/min in LMA group. SAP increased in TT group to 131 mmHg, DAP to 82.6 mmHg, whilst in LMA group both values decreased to 98.6 mmHG and 66.3 mmHg, respectively. The significant difference in IOP values was observed after intubation or using laryngeal mask. In TT group, intraocular pressure increased to 15 mmHg in healthy eye and to 13.6 mmHg in ill eye whilst there was a decrease in LMA group to 5.5 and 7.43 mmHg, respectively. Furthermore, a greater incidence of such complications as coughing, stridor and sore throat in TT group was observed. CONCLUSION: The results show that using LMA in microsurgery during general anaesthesia is more advantageous and safer for patients in comparison with tracheal intubation.

Adult↗
PubMed1996

[High-frequency jet ventilation with the HFV 970 prototype in laryngeal microsurgery: comparison of 2 injection systems].

OBJECTIVE: To describe the results obtained with the use of a high frequency jet ventilation system with the HFV 970 prototype through two types of injector, an intratracheal cannula and an endotracheal tube, in 12 patients undergoing laryngoscopic microsurgery. PATIENTS AND METHOD: After anesthetic induction with propofol and succinylcholine, an intratracheal cannula was placed in the patients in group A by way of cricothyroid membrane puncture. The tracheas of group B patients were intubated with a number 7 tube, through which was inserted the same type of cannula as had been used with group A patients. A prototype Servo HFV 970 respirator was used with the following protocol: minute volume 120 ml/min, inspiratory time 30%, respiratory rate 120 cycles/min and a FiO2 of 1. Anesthesia was maintained with propofol in continuous perfusion. The parameters studied were peak airway pressure, PCO2, PO2 and pH. Data were recorded at baseline and every 5 min thereafter until the end of surgery. RESULTS: During high frequency jet ventilation there were no statistically significant differences between groups A and B with respect to peak airway pressure. PCO2 in group A increased significantly during surgery, while in group B it decreased significantly. Oxygenation was excellent in both groups, being significantly higher than baseline values at all times studied, with no statistically significant differences between the 2 groups. CONCLUSION: Our results for the efficacy of ventilation and oxygenation with the prototype HFV 970 are similar to those published for conventional high frequency jet ventilation. Using a tracheal tube assures adequate ventilation, but supposes a tendency to entrapment, whereas use of an intratracheal cannula is associated with lower ventilatory efficacy and less entrapment. Oxygenation is excellent with both systems.

Adult↗