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At least 775 records · Page 43Linked to original sources
PubMed2004

Surgical management of spinal metastases.

Metastatic spread to the spinal column is a growing problem in patients with cancer. It can cause a number of sequelae including pain, instability, and neurologic deficit. If left untreated, progressive myelopathy results in the loss of motor, sensory, and autonomic functions. Except in rare circumstances, treatment is palliative. Traditionally, conventional fractionated external beam radiotherapy has been the treatment of choice. "Surgery" for metastatic spinal disease was, and generally continues to be, equated with laminectomy by many physicians. However, there has been a remarkable evolution in surgical techniques over the last 20 years. Today, the goal of surgery is to achieve circumferential decompression of the neural elements while reconstructing and immediately stabilizing the spinal column. This has been made possible by the use of different surgical approaches and the exploitation of a burgeoning array of internal fixation devices. More recently, minimally invasive surgical techniques, such as endoscopy, kyphoplasty/vertebroplasty, and stereotactic radiosurgery, have been added to the surgeon's armamentarium. As the number of treatment options for metastatic spinal disease grows, it has become clear that effective implementation of treatment can only be achieved by a multidisciplinary approach. This will provide the surest means of maximizing the quality of the remainder of the patient's life.

Humans↗
PubMed1983

Erectile function before and after reconstructive arterial surgery in men with occlusive arterial leg disease.

Erectile impotence is a well-known complication of vascular surgery in the aorto-iliac area. So far the pathogenesis has not quite been understood, but peroperative damage to the autonomous nerves has been suggested. Ninety-eight men with arterial insufficiency in their legs underwent an additional sexual evaluation including penile blood pressure measurement and cystometric examination. The arterial insufficiency necessitated arterial reconstruction involving aorta or the common iliac arteries in 28 patients. When possible, improvement of the penile blood supply was aimed at during the operation, but no nerve-sparing techniques were employed. The seven potent patients remained potent, while nine patients became potent after the operation. The cases remaining impotent after the operation could all be explained considering the arteriography, the operation and the changes in penile blood pressure. The erectile function is related to the condition of the penile blood supply and it may be possible to reduce the rate of postoperative impotence by considering the penile blood supply when planning the operative strategy.

Adult↗
PubMed1975

[The external laryngeal nerve].

An investigation on the external laryngeal nerve is carried out from cadeverous material (24 thyroid glands). Various origins of the nerve are reported. The relationships are investigated. They are particularly important on the superior pole of the thyroid gland. The nerve may pass at a variable distance of the superior pole of the thyroid gland. The size of the gland and particularly the more the more or less early intramuscular course of the nerve through the fibers of the inferior pharyngeal constrictor muscle determine the relationships. Those relationships will be made closer if the nerve is adherent to the thyroid sheath, passes forward of the superior thyroid artery or between the supra polar branches. The collateral nervous branches for the thyroid gland or for the thyroid vessels, the arterial branches which passed into the pharyngeal constrictor muscle with the nerve may also change the relationships. Practical applications in thyroid surgery are made through this investigation.

Ganglia, Autonomic↗
PubMed2005

GIST of pancreas.

Authors present the case (from the year 2003) of a 38 years old patient, female with large tumor in the abdominal cavity. Preoperative differential diagnostic examination showed either tumor of pancreas or left liver lobe. The surgery confirmed large tumor body of the pancreas. Histological and immunohistochemical examination determined gastrointestinal stromal tumor (GIST) of the pancreas from autonomous nerves with malignant character. Tumor was radically removed. In the postoperative period regular follow up was done at the department of oncology, abdominal ultrasound every 3 months, CT scan every 6 month. 2.5 years after operation the patient has no problems, CT scan is without signs of recurrent diseases. The analysis of GIST was performed in agreement with contemporary knowledge. According to the references, our case report GIST of pancreas is the first of this kind (till 2003).

Adult↗
PubMed1995

Total mesorectal excision in the operative treatment of carcinoma of the rectum.

BACKGROUND: Total mesorectal excision (TME) is reported to reduce local recurrence and improve survival rates in patients with carcinoma of the rectum. STUDY DESIGN: Two hundred forty-six consecutive patients with Dukes' B (T3, N0, M0) and C (T(any), N1-2, M0) primary rectal carcinomas underwent operation according to the principle of TME. Kaplan-Meier estimates of survival and pelvic recurrence rates were calculated from a database of patients followed prospectively. RESULTS: The operative mortality rate was 0.8 percent (two of 246). The Kaplan-Meier five-year survival rate for patients with stages B and C was 74.2 percent; for patients with stage T3, N0, M0, 86.7 percent; for patients with stage T(any), N1-2, M0, 64.0 percent; and for patients with substage T3, N1-2, M0, 68.0 percent. Pelvic recurrences were observed in a total of 18 patients (7.3 percent) with or without metastases. In the 246 patients with Dukes' stages B and C, pelvic recurrence rates were 4.0 and 8.1 percent, respectively, in the presence or absence of distant metastases, and 3.0 and 5.8 percent, respectively, in the absence of distant spread. Statistically significant risk factors for pelvic recurrence were N2 disease and perineural invasion. Adjuvant radiation therapy was of no statistical benefit in preventing local recurrences. CONCLUSIONS: Total mesorectal excision cures carcinoma of the rectum and provides excellent local control through resection of the entire unit of regional spread that is excised, intact and with negative circumferential margins. Total mesorectal excision is compatible with autonomic nerve preservation and with sphincter preservation. The current role of combined modality adjuvant therapy, which is standard therapy following conventional surgery, should be reconsidered in patients who have undergone resection in accordance with TME.

Adult↗
PubMed1996

[Drug therapy of atrial fibrillation].

Atrial fibrillation can, clinically, be differentiated into several subgroups. Paroxysmal atrial fibrillation lasts less than 24 hours and is often caused by an autonomic dysregulation. Chronic atrial fibrillation occurs in a reversible and an irreversible form. Atrial fibrillation is frequently observed transiently after cardiac surgery. The therapeutic goal must be clearly defined before treatment is initiated. In patients with a reversible form of chronic atrial fibrillation, sinus rhythm can be restored with class Ia, Ic and III antiarrhythmic drugs. These patients with sinus rhythm benefit from higher cardiac output, fewer thromboembolic complications and fewer symptoms (no palpitations). In patients suffering from an irreversible form of chronic atrial fibrillation the therapeutic aim is control of ventricular rate. Digoxin, beta-blockers (class II) and calcium antagonists (class IV) are successfully used to slow atrioventricular conduction. Patients aged over 65 years should be anticoagulated, since numerous studies have shown a marked decrease in thromboembolic complications with warfarin.

Aged↗
PubMed2003

Computer-based approaches for maxillofacial interventions.

Computers used as supporting tools for diagnostics, operation planning and therapy are of increasing relevance in surgery. Rapid progress in imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRT) and ultrasound already allows to represent anatomical and physiological conditions with maximal authenticity. In order to simulate complex surgeries we must develop ergonomic and intuitively useable software tools, thus enabling a precise and fast virtual execution of the planned surgical intervention preoperatively. Intraoperative support will consist of passive navigation tools, available already today, supporting the intraoperative orientation and, in the future, robots performing specific steps autonomously. Methods of augmented reality for the interaction of virtual objects and the real surgical scene are also suitable for the visualization of planning data and other medically relevant information in the operation situs . In maxillofacial and craniofacial surgery the techniques mentioned have been applied in all fields from dental implantology up to the correction of craniofacial malformations and the resection of skull base tumors. Many applications are still being developed or are still in the form of a prototype. However, it is already clear that developments in this area will have a considerable effect on a surgeon's routine work.

Journal Article↗
PubMed2004

A strong nerve dependence of sonic hedgehog expression in basal cells in mouse taste bud and an autonomous transcriptional control of genes in differentiated taste cells.

The nerve-dependency of gene expression in mouse taste bud was examined through an analysis of changes in gene expression in and around the taste buds in circumvallate papillae after surgery of cranial nerve IXth (glossopharyngeal nerve). The number of cells expressing T1r3, gustducin, Mash1 and Nkx2.2 gradually decreased after denervation. However, the expression intensity of these genes was barely influenced by denervation, and strong expression was observed at 6 days after denervation. In contrast, the basal cell-specific Sonic hedgehog (Shh) expression in the taste buds was decreased markedly at 6 h after denervation. In the regeneration process of taste buds, Shh expression was observed during a very early phase before taste bud formation. These results indicate the autonomous transcriptional control of genes in differentiated taste cells and the strong nerve-dependency of Shh expression in basal cells. Furthermore, in order to reveal the mitotic activity of Shh-expressing cells in taste buds, the BrdU-labeling experiments were performed using a combination of BrdU-immunohistochemistry and in situ hybridization. BrdU-signal was very rarely observed in Shh-expressing cells immediately after BrdU injection, and the signals were noted mainly in Ptc-expressing cells. BrdU signals rapidly increased in Shh-expressing cells in following 12 h and began to decrease after 2 days post-injection. These results suggest that most Shh-expressing cells are not mitotically active, but that Shh-expressing cells may be in the early transient developmental state of taste cells in taste buds.

Animals↗
PubMed1997

Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases.

Relevant English language articles published from 1966 to 1995 regarding ethanol therapy in the treatment of thyroid and parathyroid diseases were identified through a MEDLINE search and manual searches of identified articles. The sclerosing properties of ethanol have been recognized for many years and have offered interventional possibilities in the management of various benign as well as malignant lesions. The mechanism of action of ethanol appears to be related to a direct coagulative necrosis and local partial or complete small vessel thrombosis. Ultrasound-guided percutaneous ethanol injection therapy (PEIT) is rapid and performed on an out-patient basis and has now gained wide acceptance due to the accumulating evidence of the efficacy and safety of this therapeutic tool. Yet, there is a lack of prospective, randomized clinical trials comparing PEIT with 131I therapy or surgery with regard to its effects, especially long-term ones and it should therefore still be considered an experimental procedure. In benign endocrine diseases, PEIT has shown promising results in the treatment of autonomous thyroid nodules, benign solitary cold solid as well as cystic thyroid nodules and parathyroid tumours. Its use in pretoxic and toxic thyroid nodules has been evaluated in several uncontrolled studies, all demonstrating a high success rate in spite of the large number of treatments needed. So far efficacy and cost-effectiveness seem inferior to 131I and surgery. Short-term results of PEIT in benign cystic thyroid nodules are convincing with a high cure rate, but no controlled studies with long-term results are available. Preliminary results suggest that PEIT could become an alternative to surgical excision or levothyroxine therapy in the symptomatic solid cold benign thyroid nodule. Ultrasound-guided PEIT of parathyroid tumours has proven to be a useful method in highly selected patients in whom surgery has been found non-attractive and medical treatment ineffective. However, no prospective randomized trials have been published comparing the results of PEIT in parathyroid tumours with conventional surgical and medical treatments. PEIT has never been tested against standard therapy, but seems inferior to 131I and surgery. Side-effects caused by ethanol injection are generally few and transient and are related to the injection into solid nodules rather than cysts. Ethanol injection into solid profund nodules may seriously jeopardize subsequent surgery because of perinodular fibrosis. As an experimental procedure, not yet evaluated sufficiently, it should be reserved for patients who cannot or will not undergo standard therapy. Caution in routine use is advisable.

Administration, Cutaneous↗
PubMed1992

Analysis of heart rate variability to assess hemodynamic alterations following induction of anesthesia.

Extensive changes in hemodynamics and cardiac rhythm during induction of anesthesia may be mediated by altered responses of the autonomic nervous system to anesthetic agents. Analysis of the power spectrum of the heart rate (PSHR) variability can supply information about the autonomic nervous system, and may be used in order to assess this phenomenon. In this study, 78 patients undergoing coronary artery bypass graft surgery were evaluated. Anesthesia was induced with sufentanil, and neuromuscular blockade with vecuronium, a combination that may cause a decrease in heart rate. Before and after induction of anesthesia, the heart rate (HR), blood pressure (BP), cardiac output (CO), cardiac index (CI), and PSHR components were recorded. PSHR was obtained by using a special algorithm and data acquisition system for real-time spectral analysis. A low-frequency component (LFa, mainly sympathetic) was analyzed from a band of 0.04 Hz to 0.1 Hz. A high-frequency component (RFa, parasympathetic) was identified by the respiratory frequency spectrum. Alterations of the heart rate after induction of anesthesia were defined in order to separate the patient population into two groups: slow heart rate (slow-HR) and stable heart rate (stable-HR). Slow heart rate was defined as a decrease in HR of more than 20% of the baseline value. The variables were analyzed and compared between the slow-HR (n = 25) and stable-HR (n = 53) groups in order to verify the possibility of identifying patients prone to hemodynamic changes after anesthesia induction. There were no differences in preoperative HR, BP, CO, or CI between groups before anesthesia induction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

[Historical review of colorectal cancer surgery].

The classical standard surgical technique for rectal carcinoma, abdominoperineal excision (Miles operation), has been gradually replaced by sphincter-saving surgery and more than 70% of rectal carcinomas are treated by anterior resection in which autosuture machines have played a major role in recent years. Wide lateral lymphadenectomy has been replaced by autonomic nerve preservation because of the high frequency of sexual and urinary dysfunction. Total mesorectal excision (TME) proposed by Heald et al which ignores the lateral nodes of the pelvic wall is the most popular technique in Western countries. The concept of TME is contradictory to that of wide lateral lymphadenectomy and the true merits of the latter should be examined in the near future. Minimally invasive surgery, including various procedures of local excision of low rectal tumors and colonoscopic polypectomy, has given great benefits to many patients. In Japan there seems to have been a lack of interest in adjuvant radiotherapy and chemoradiotherapy in the past, but they should be more seriously considered for the adjuvant treatment of advanced rectal carcinoma in the future.

Colonoscopy↗
PubMed1983

Prototype of a multipurpose trilaser unit in a teaching hospital surgical department.

We describe our experience and the problems we encountered organizing an autonomous surgical unit in which the equipment and organization enable three lasers to be used in may different applications in medicine and surgery. The three lasers--CO2, Nd:YAG, and argon--may now be used by all the departments concerned within our teaching hospital. As our unit goes into operation, we have determined that we must now begin an evaluation 1) To assess the clinical value of laser usage via the careful selection of cases for laser treatment, the storage of data for future reference on card and computer records, and the assessment of the vital role of the laser within a range of modern therapeutic aids; 2) to achieve technical improvements, by the optimum use of laser sources and related optical equipment; and 3) to assess the economics of the unit, the profitability of bringing together the three types of laser, and the total cost involved.

France↗
PubMed1982

Serum thyroid hormone concentrations and recovery of TSH secretion after excision of autonomously functioning thyroid nodules.

Serum concentrations of TSH, TT4, TT3 and rT3 were monitored for one month after excision of ten autonomous thyroid adenomas which had suppressed TSH secretion. Basal serum TSH levels start to increase between 30 hr and 20 days after surgery reaching normal and steady levels by the 24 day. Serum TT3 concentrations rapidly decrease in the first 20 hr to values near the lower limit of the normal range. Thereafter TT3 levels change little until pituitary TSH secretion recovers. Serum TT4 levels also fall, but much more slowly than TT3. Rising TSH levels stimulate residual extranodular thyroid tissue secretion of both TT3 and TT4. However, serum TT3 levels rise more rapidly than TT4 levels. Preoperative serum concentrations of both TT4 and TT3 are related directly to the time required until the beginning of the postoperative rise in TSH levels, and inversely with the maximal postoperative serum TSH concentration achieved. Throughout the study period, for all patients, serum TSH concentrations were inversely related to serum TT4 concentrations. These data suggest that, although the time required until the onset of recovery of TSH secretion is directly related to preoperative levels of TT4 and TT3, the regulation of postoperative TSH levels is dependent upon serum TT4 levels. Also, the serum TT3 levels constant at the lower limit of the normal range before recovery of TSH secretion, and the preferential rise in serum TT3 concentrations associated with rising TSH secretion, may prevent or abbreviate temporary postoperative hypothyroidism.

Adenoma↗