The prevalence of sexual behavior disorders in patients with treated and untreated gastroesophageal reflux disease

Background Gastroesophageal reflux disease (GERD) is a chronic disease. Sexual behavior is often altered in chronic illness. The aim of this study was to evaluate sexual behavior in patients affected with GERD before and after medical or surgical treatment in comparison to healthy controls (HC). Methods Upper GI endoscopy and 24-h ambulatory pH testing were performed to confirm GERD in symptomatic patients. GERD patients completed an anonymous questionnaire on sexual life before and after medical or surgical treatment. Results Compared with HC, untreated patients with GERD showed more frequent difficulty in attaining orgasm and painful intercourse. GERD patients after surgical treatment had significantly more difficulty in attaining orgasm, while after continuous medical treatment GERD patients compared with HC had significantly more difficulty in attaining orgasm, higher painful intercourse, lower sexual desire, and perceived more frequently that the partner was unhelpful. When compared with untreated conditions, GERD patients after surgical treatment had a significant improvement in attaining orgasm and in painful intercourse but a significant decrease in sexual desire, a lower satisfaction with their sexual life, and a higher prevalence of an unhelpful partner, whereas GERD patients after medical treatment had a decrease in all indices of sexual behavior. Conclusion Untreated GERD is associated with disorders in sexual behavior. Compared with HC, only the surgical group partially improved after treatment.     

Surgical therapy of Crohn's disease: observations on 63 patients

AIM: The purpose of our retrospective study is to evaluate the correct indications for the surgical therapy of Crohn's disease. METHODS: Our case series consists of 63 patients admitted to our Surgery Department from January 1, 1973 to December 2002 with a diagnosis of Crohn's disease. Of the 56 operated patients, 43 patients were followed-up. For an objective evaluation of the Crohn's disease activity, the Crohn's Disease Activity Index (CDAI) was used. Surgical treatment has been carried out in 56 cases: in 29 cases of intestinal occlusion a minimal gut resection was performed; in the 26 cases of perforation a suture of the perforation was preferred, with a drainage of the peritoneal cavity and a toilette of abscess when it was present, and in 1 case an ileocolic resection was performed. RESULTS: Only 1 case showed a CDAI score >150 (153.63). This shows that in all the other cases the surgical and medical treatment has led to a satisfactory control of the disease. A relapse has been observed in 17 patients after an average period of 5 years without showing signs of disease. CONCLUSION: It is suggested that Crohn's disease therapy should be mainly of a medical nature and surgical treatment should be reserved for complicated cases.     

急性坏死性胰腺炎早期手术治疗分析（附19例报告）

本文报告对１９例急性坏死性胰腺炎早期手术（２４小时内）治疗的结果，存活率达１００％。就早期手术的理论依据、早期手术的指征、手术时机和手术方式进行了讨论。作者认为，早期手术的成功取决于充分的胰腺减压、彻底的坏死组织清除和有效的引流及冲洗。     

A rare cause of neuromuscular scoliosis: Alexander disease

Alexander disease belongs to a group of progressive neurological disorders in which the destruction of white matter in the brain is accompanied by the formation of fibrous, eosinophilic deposits known as Rosenthal fibers. Spinal deformity rarely accompanies this disease. The aim of this report is to present a patient with juvenile-onset Alexander disease, who also had progressive neuromuscular type scoliosis requiring surgical stabilization. A 13-year-old male presented with bilateral weakness in both lower extremities and scoliosis. Results of an examination of the spine showed a left thoracic scoliosis with prominent left paraspinous prominence and elevation of the ipsilateral shoulder. Spinal fusion with rigid internal stabilizing instrumentation was selected for surgical treatment of the scoliosis. The fusion area was to be from T2 to L4. He was instrumented with pedicle screw fixation system, and he underwent fusion with an allogenous bone graft. Satisfactory correction of the sagittal and coronal plane deformity was achieved, reducing the scoliosis to 14°. At the 5-year follow-up, results of a clinical examination showed a marked improvement in truncal balance and walking ability. The patient had a rapidly progressive scoliosis and severe decompensation requiring surgical stabilization. The scoliosis behaved in a manner similar to that of neuromuscular scoliosis. Therefore, more aggressive treatment was warranted to prevent decompensation. For that reason, posterior long segment (T2–L4) pedicle screw instrumentation and fusion was performed for surgical treatment.     

桥本病的诊断和治疗: 附51例报告

目的 探讨桥本病的诊断和治疗方法。方法 总结近15年来收治的桥本病51例的临床资料。结果 51例中误诊率为78．4％。37例行手术治疗，效果满意。其中30例获得随访，随访率为81．1％；术后发生甲状腺功能减退共6例，占手术患者的16．2％，经服用甲状腺素片制剂后症状消失。结论 甲状腺球蛋白抗体、甲状腺微粒体抗体的检测以及术中冷冻切片有助于本病的诊断；对合并有甲状腺结节的桥本病怀疑有癌变、或伴有气管、食管、喉返神经压迫症状、或甲状腺素片制剂抑制治疗无效的患者施行恰当的手术是一种有效的治疗方法。     

A comparative synchronous coronary surgery survival study.

Utilizing patient criteria published by the Veterans Administration Cooperative (VAC) Study, a cohort of 229 surgically treated patients was retrieved from the Milwaukee Cardiovascular Data Registry. These patients were all operated on by one surgeon during 1972 to 1974. Four-year survival of this group was compared with that of the medically treated cohort of 310 patients from the VAC Study. Operative mortality was included in all surgical groups. The cumulative 4-year survival of both groups revealed a 95 to 85% advantage for surgical therapy. In patients with three-vessel disease, the cumulative survival favored surgical therapy--94% compared with 80% in the medically terated cohort--and in patients with triple-vessel disease and a normal left ventricle, surgical therapy again showed better results: 100% compared with 88%. Patients with two-vessel disease and a normal left ventricle who underwent surgical intervention had slightly better 4-year survival than those who had medical treatment--100% versus 95%--and those with two-vessel disease and an abnormal left ventricle had a 93% survival after surgical treatment compared with 84% for those with medical treatment. For patients with single-vessel disease, there was no difference in survival between the surgical and medical cohorts.     

小剂量罗哌卡因鞍麻在肛肠病合并心血管病手术中的应用

为观察小剂量罗哌卡因鞍麻在肛肠病合并心血管病手术中的应用，将300例肛肠病合并心血管病患者随机分为观察组和对照组各150例，即小剂量罗哌卡因鞍麻组和局麻组。结果显示，小剂量罗哌卡因鞍麻镇痛完全，明显降低了麻醉及手术的并发症，提高了手术的安全性。结果表明，小剂量罗哌卡因鞍麻是适用于肛肠病合并心血管病患者手术的麻醉方法。     

Methods of surgical stabilization for metastatic disease of the spine

A variety of surgical techniques is available for treatment of metastatic disease of the spine. Prior emphasis on the use of these procedures has been on their benefit as a palliative measure to relieve signs and symptoms of spinal cord and nerve root compression not aided by radiation therapy and corticosteroid administration. More recently, development of surgical techniques that combine neural decompression with restoration of spinal stability has brought about consideration of additional indications for surgery in the treatment of metastatic disease of the spine. The present scope of such surgical procedures is reviewed along with identification of the most reliable selection factors for surgical candidates in order to improve functional outcome from surgical treatment of metastatic disease of the spine. Over 70 surgical series with more than 2,000 patients treated were reviewed.     

先天性心脏病介入治疗后封堵器移位的急诊外科治疗

目的 探讨先天性心脏病（先心病）介入治疗后封堵器移位的原因以及急诊外科治疗的必要性和方法。方法 5例先心病病儿在接受介入治疗术后的数分钟到数天内封堵器部分移位或完全脱落，其中2例动脉导管未闭病儿封堵器分别脱落至左、右肺动脉开口处，2例房间隔缺损病儿封堵器部分移位造成残余分流，1例室间隔缺损病儿封堵器部分移位，封堵器尖端将三尖瓣前瓣腱索割断造成三尖瓣中到重度反流。5例在封堵器移位当日到1个月内在体外循环下急诊行封堵器取出术和先心病纠治术。结果 手术效果满意，5例病儿均未出现重要脏器功能损害，心功能恢复至Ⅰ级。结论 封堵器移位是先心病介入治疗后较严重的并发症；为防止和避免封堵器移位应严格掌握介入治疗术的指征和选择尺寸合适的封堵器；介入治疗术后早期应加强各项心脏专科检查和监测，一旦发现封堵器移位应紧急手术以避免病情恶化；只要处理及时，手术效果满意，心功能恢复良好。     

New Minimally Invasive Surgical Technique Using Arterial T-grafts for Treatment of Double-vessel Coronary Artery Disease: Experimental Study

Minimally invasive surgery has been used successfully in patients with single-vessel coronary artery disease (CAD), but there are no clinical reports of surgical techniques for the treatment of multivessel disease in this field using both internal mammary arteries (IMAs). Therefore a canine model has been established to demonstrate the feasibility of a minimally invasive surgical treatment of coronary artery double-vessel disease using both IMAs. Ten mongrel dogs underwent bilateral thoracoscopic preparation of both internal mammary arteries through small left lateral chest ports. Using the Port Access endovascular cardiopulmonary bypass system the right IMA (RIMA) was anastomosed as a free graft end-to-side to the left IMA (LIMA) as a T-graft. After induction of cardioplegic arrest the RIMA was anastomosed to the circumflex artery and the LIMA to the left anterior descending artery. All animals were weaned from cardiopulmonary bypass without inotropic support. The electrocardiogram showed sinus rhythm with no signs of ischemia. Intraoperative coronary angiography demonstrated patency of all anastomoses. The minimally invasive surgical treatment of double-vessel CAD using arterial T-grafts of both IMAs is thus feasible. Surgical trauma can be further reduced by harvesting the RIMA transmediastinally through the left lateral chest.     

Effectiveness of kampo medicine gorei-san-ryo for chronic subdural hematoma in very elderly patients

Chronic subdural hematoma (CSDH) is mainly a disease of the elderly. Widespread use of CT and MRI has resulted in the discovery of CSDH cases with no or minimum symptoms in the elderly. Treatment is by surgical evacuation, although small hematoma may resolve spontaneously. Treatment of CSDH in elderly patients of more than 80 years of age with minimum symptoms is still undetermined. Many conservative treatments such as those with steroids and diuretics have been reported with some good results. Conservative treatment cannot become the procedure of choice for fear of side effects. We report successful treatment for CSDH cases among the very elderly with a Kampo medicine (Japanese traditional herbal medicine). Among a total eleven cases, four were recurrent after surgical evacuation and seven showed significant hematoma with minimal symptoms. Gorei-san-ryo, a Kampo medicine, was administered for 3 to 12 months. Some cases showed rapid hematoma resolution after administration. Only one of them required subsequent surgical intervention. This conservative treatment with Kampo medicine for CSDH may be a potential alternative to surgery especially for the elderly.     

Surgical correction of renovascular hypertension

The role of surgical revascularization in the management of patients with renal artery disease has changed in recent years. This has occurred owing to the advent of transluminal angioplasty as an effective method of treatment for certain patients, improved results of surgical revascularization in older patients with atherosclerosis, an enhanced appreciation of advanced atherosclerotic renal artery disease as a correctable cause of renal failure, and the development of more effective surgical techniques for patients with severe aortic atherosclerosis and branch renal artery disease. Surgical revascularization is at present the treatment of choice for patients with branch renal artery disease, ostial atherosclerotic renal artery disease, a renal artery aneurysm, and patients in whom renal angioplasty has been unsuccessful. Excellent clinical results continue to be achieved with surgical revascularization in properly selected patients.     

Middle lobectomy for bronchiectasis: clinical case and review of the literature

Over the past few years bronchiectasis, among the chronic lung diseases, has been the second most important after tuberculosis in terms of frequency and mortality. Although the incidence of the disease has been decreasing in recent years, the illness is currently of great surgical interest because of an upsurge of cases among people considered to be below the bread line. The authors present the clinical case and surgical treatment of a young adult with middle lobe bronchiectasis, with a 10-year primary IgG deficiency and severe bronchopneumonia requiring hospitalisation. Medical treatment, long regarded as the treatment of choice in this condition, has reduced the short-term morbidity of patients suffering from the disease, without affecting its ultimate mortality which is still very high today. The policy in the past to reserve surgery only for the most complicated cases or for patients not responding to medical treatment can now be considered obsolete, due to the reduced surgical risks (less than 1%) and to faster patient recovery. Further surgical indications are mono- or bilaterally located forms of the disease and failure to respond to medical treatment for more than 2 years. A review of the literature enables the authors to affirm that in the absence of randomised trials on the effectiveness of surgical vs medical treatment, it seems clear that surgical therapy is the best option, being curative and safe, with a high percentage of complete remission of disease and very low operative risks and mortality. It can therefore guarantee good quality of life, radically changing the prognosis which otherwise is fatal in 1/3 of patients suffering from this orphan disease.     

Surgical reconstruction without preoperative angiography in patients with aortoiliac occlusive disease

The objective of this study was to evaluate the feasibility of performing surgical reconstructions in patients with aortoiliac occlusive disease with findings obtained solely from duplex scanning. Between January 1995 through December 1999, among 112 patients who underwent surgical intervention due to aortoiliac occlusive disease, 44 were operated on with findings obtained solely from preoperative duplex scanning. Deviations from preoperatively planned surgical interventions according to duplex scan findings and the outcome were analyzed. Our results showed that surgical reconstructions for treatment of aortoiliac occlusive disease can be safely performed by using duplex scanning as the sole preoperative diagnostic modality in patients with conclusive duplex scan findings.     

Is there a role for surgery in patients with "unresectable" cKIT+ gastrointestinal stromal tumors treated with imatinib mesylate?

BACKGROUND: Imatinib mesylate (Gleevec) is being studied as adjuvant chemotherapy for the treatment of cKIT+ gastrointestinal stromal tumors (GISTs). Early reports using Gleevec for the treatment of unresectable GISTs have shown 50% to 60% partial response rates based on radiographic evaluation alone. No study has yet correlated radiographic response with pathologic findings. This retrospective review of patients with cKIT+ GISTs who received Gleevec prior to surgical resection examines the pathologic response to therapy and the feasibility of surgical resection after treatment. METHODS: Patients with cKIT+ GISTs were identified from the institutional sarcoma database. Patients were included if they had pathologic confirmation of cKIT mutation and therapy with Gleevec. The pretreatment and preoperative radiographs, surgeons' operative notes, and pathology reports were reviewed for documentation of the extent of disease. RESULTS: Between January 2001 and Octorber 2002, 126 patients with unresectable cKIT + GISTs treated with Gleevec were identified. Of these 126 patients, 17 have subsequently undergone surgical resection after a median of 10 months (range 2 to 16) of treatment with Gleevec. Based on computed tomographic (CT) scanning, 1 (6%) patient had evidence of a complete tumor response, 12 (70%) patients had a partial response, 3 (24%) patients had stable disease, and 1 (6%) patient had progressive disease. Posttreatment/preoperative CT imaging documented an overall response rate of 76%. The pathologic review of the operative specimens showed that 2 (12%) patients had a complete response to therapy, 11 (65%) had a partial response to therapy, 3 (18%) patients had no evidence of treatment effect on the excised tumor, 1 patient had progressive disease. Sixteen patients (94%) underwent complete surgical resection of disease, including 3 patients with no pathologic evidence of response to therapy. One patient had progression of disease and was unresectable at surgical exploration. CONCLUSIONS: This series is the first to present pathologic data after the treatment of cKIT+ GISTs with Gleevec. In this series, the majority of responses were limited to partial responses, indicating that surgical resection remains a vital component of the treatment plan for patients with cKIT+ GISTs. This series is consistent with previous reports indicating that complete responses are extremely rare in response to treatment with Gleevec. Patients with advanced disease may benefit from a course of neoadjuvant therapy with Gleevec followed by resection, even when there is evidence of multifocal disease. A prospective evaluation of neoadjuvant Gleevec therapy for advanced cKIT+ GISTs is warranted.     

预防性手术治疗结直肠克罗恩病7例

为探讨预防性手术治疗结直肠克罗恩病的疗效，回顾分析7例结直肠克罗恩病患者的资料。结果显示，7例患者手术治疗共23次，手术方式以肠段切除吻合术最多（21／23，91．3％）；肠段切除范围在保证血运通畅的条件下尽量多地保留肉眼可见的正常肠段；手术后复发率为69．6％（16／23）；切缘阳性的复发率为75．0％（9／12），切缘阴性的复发率为63．6％（7／11），组间差异无统计学意义（P〉0．05）。结果表明，结直肠克罗恩病肠管切除范围及切缘有无病变残留不影响术后复发率；预防性手术是其一种有效的治疗方法，可以减少并发症的发生，提高患者生活质量，但不能改变其基本病程进展。     

Crohn's disease--when to operate?

Crohn's disease is a chronic bowel condition, which can present as a number of different clinical and pathological presentations, depending on localization and activity of the inflammatory process. The aethiology of the disease has not been explained. In each case the treatment should be individually tailored depending on the type of the changes. The indications for surgical intervention are continuous bleedings, recurrent ileus, perforation of the intestine, abscesses, fistulas, failure of pharmacological treatment, resistance to steroids and steroid dependence. In case of the mild type of the disease with few symptoms pharmacological treatment is the right choice In case of the mild type of the disease with few symptoms pharmacological treatment is the right choice process. In malign form of Crohn's disease lack of improvement after 7-10 days of intensive treatment is generally accepted indication for surgical treatment. Fulminant form of the disease is still a clear-cut indication for immediate surgical intervention. Decision on surgical intervention is more difficult and controversial when patient presents with series of subileus recurrences subsiding after conservative treatment. Patients with stenotic form of Crohn's disease usually require multiple operations most of which are bowel resections. Patients with stenotic form of Crohn's disease usually require multiple operations most of which are bowel resections therapy. External and internal asymptomatic fistulas should be treated conservatively. The timing of surgical treatment is essential in Crohn's disease however the prevention from recurrences is also fundamental. It is well proved that preventive administration of 5-ASA (especially mesalazine) and metronidazol can reduce the risk of early recurrences after surgery.     

History of the development of surgical treatments for moyamoya disease

Many surgical treatments for moyamoya disease have been developed over the past 40 years. The optimum treatment for ischemic-type moyamoya disease is almost established. The first surgical treatment for the disease was the superficial temporal artery to middle carotid artery (STA-MCA) anastomosis. The discovery of spontaneous collateral formation following the STA-MCA anastomosis surgery led to the development of various indirect bypass procedures. Collateral formation and clinical outcomes from direct and indirect procedures have been compared to assess the merits and limitations of each technique. Experience and a greater understanding of the surgical effects of moyamoya disease have led to the development of surgical procedures combining various direct and indirect bypass techniques for optimal restoration of perfusion. This review of the historical development and efficacy of each procedure will aid surgeons in selecting the most appropriate surgical procedure for patients of different ages with different symptoms and disease severities.     

Extra-anatomic Bypass Grafting after Endovascular Embolization for the Treatment of Mycotic Aneurysm - 2 case reports -

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.     

Operative indications and options in intestinal Crohn's disease

Multidisciplinary management of Crohn's disease is mandated by the complexity of the clinical scenarios and interfaces between medical treatment, nutritional support, and surgical interventions. Surgery is a critical component of the treatment algorithm intended to improve patient symptoms and quality of life, resolve disease-associated complications, and maximize efficacy of medical therapy.The most common procedure performed for intestinal Crohn's disease is resection of the affected segment of bowel with primary anastomosis when feasible and indicated. Different surgical techniques have been proposed with the goals of limiting postoperative complications and preventing surgical recurrences. Selected patients affected by intestinal Crohn's disease are at especially increased risk for repeated surgical intervention and bowel sparing techniques have been developed to reduce the risk of short bowel syndrome in this population.The clinical scenarios of intestinal Crohn's disease vary as to when surgery is indicated and what techniques should be employed. Multiple surgical options might be used in a single patient with multifocal disease with an intent to provide a longer remission time. The important role of preoperative optimization and postoperative treatment reinforces the notion that timing and coordination of medical and surgical treatments is crucial in this debilitating and complex disease.