First thoracic disc herniation with myelopathy

Summary The case of a patient with progressive paraparesis due to first thoracic disc herniation is reported. He was treated successfully with anterior interbody fusion by the Smith-Robinson approach. An anterior approach is desirable for surgical treatment of T1/2 disc herniation, and up to this level the Smith-Robinson approach, without thoracotomy, is entirely possible.     

Alternative treatment of gluteofemoral fistulas using honey: a case report

Perianal fistula is a common disease that affects particular patients with inflammatory bowel disease. Honey has been used as a natural remedy for centuries for the treatment of various disorders. We report a patient with persistent fistulas, in whom conventional medical and surgical therapy failed. In this case, most of fistulas in gluteofemoral region were completely healed and closed after 6 months of treatment with honey. In addition, honey reduced inflammation, pain and induration of affected region. This medical approach positively affected patient's mental condition and also improved his quality of life.     

Scoliosis associated with Prader-Willi syndrome.

BACKGROUND CONTEXT: Prader-Willi syndrome is a rare disease associated with a variety of musculoskeletal abnormalities, including scoliosis, joint hyperlaxity, and delayed bone age. To the authors' knowledge, only a few cases of surgical treatment for scoliosis associated with Prader-Willi syndrome have been reported. PURPOSE: To report a rare case of scoliosis associated with Prader-Willi syndrome and the effect of surgical treatment and to review the literature on this condition. STUDY DESIGN/SETTING: Case report of a patient treated in Gifu, Japan. METHODS: The patient, a 16-year-old girl with Prader-Willi syndrome, had severe scoliosis with triple curves (T1 to T5, 43 degrees T5 to T11, 60 degrees; T11 to L3, 52 degrees), making it difficult for her to maintain balance while standing or walking. She underwent surgical correction and fusion for the scoliosis via the posterior approach. She was followed up for 2 years, and her clinical symptoms and plain X-ray films were evaluated. RESULTS: The thoracic curve was corrected to 21 degrees (correction rate, 65%) and the lumbar curve to 28 degrees (correction rate, 46%). Her symptoms were relieved. CONCLUSION: A case of scoliosis with Prader-Willi syndrome was successfully treated surgically using a posterior approach and minimizing possible risks associated with surgery in patients with this syndrome.     

Surgical treatment of hip dysplasia through the medial approach

Open reduction of developmental hip dysplasia by the medial approach is one of the effective surgical treatment methods during early childhood. Although surgical approaches, fixation and follow-up methods may vary, successful results can be obtained by the algorithm involving the posteromedial approach and arthrographic evaluation. The aim of open reduction by the medial approach should be to obtain T?nnis grade I arthrographic reduction of the dysplastic hip and to maintain it. Avascular necrosis of the femoral head is a potential complication of this method. Even though actual evaluation of this problem requires monitoring patients until maturity, it is essential that special attention be given to the most effective factors (minimal invasive surgical technique, correct reduction, and appropriate position for fixation) for preventing this complication.     

Noma: the Sokoto approach

On October 1996 a Dutch-German medical team spent three weeks in Sokoto, Nigeria to initiate a surgical aid program for the treatment of noma. For logistic reasons a semiquantitative classification system for noma was devised, describing the extent of tissue loss of anatomical units such as the nose, the outer cheek and the inner lining of the cheek, the upper lip and lower lip, and the degree of trismus (NOITULP). This system proved useful in planning the operations of the 23 noma patients treated during this period and may be helpful for future evaluation of postoperative results and the development of standardized treatment. For patients with severe trismus an intubation strategy was developed. If two attempts at blind intubation had failed, the policy was: quick cutting of the scar tissue supposedly causing the trismus and intubation (QCI). If this approach failed a Seldinger minitracheostomy was performed. In eight patients with severe (T3, T4) trismus this procedure was performed. In three patients a minitracheostoma was necessary. The operative procedures consisted of a large variety of local flaps. Forehead flaps and cervical rotation flaps were used most frequently. In four patients wound healing was complicated necessitating additional surgical treatment. Received: 9 June 1997 / Accepted: 19 January 1998     

Transmanubrial osteomuscolar sparing approach for T1-T2 thoracic disc herniation

Herniated thoracic disks are rare entities and their surgical treatment comprises 0.15% to 4% of all disk operations. Surgical approaches have included pediculectomy, costotransversectomy, lateral extracavitary, transthoracic thoracotomy, and thoracoscopy. The authors present a transmanubrial osteomuscular sparing approach for the treatment of T1-T2 thoracic disc herniation that is likely to be the only one described in the literature for this disease so far.     

T_(1b)期肾肿瘤外科治疗方式的选择:根治性肾切除术与肾部分切除术

近十余年来,局限性肾肿瘤的外科治疗方式发生了明显的变化。目前对于肿瘤直径4cm且≤7cm的临床T1b期肾肿瘤,外科手术方式的选择仍存在争议。本文介绍了T1b期肾肿瘤的外科手术治疗情况,并对手术方式的选择进行了探讨。     

Resection for esophageal cancer: strategies for optimal management

There are several controversies in the optimal management of esophageal cancer, including the surgical approach, extent of resection, and the role of multimodality treatment. Optimal surgical treatment strategies include patient selection, accurate staging and risk assessment, selection of an appropriate surgical approach, and the use of multimodality treatment in the management of these patients. In addition, other factors such as hospital and surgeon volume are important in reducing the risks of esophagectomy. In this article we discuss our approach and review the literature on these aspects that have an impact on outcomes after esophagectomy.     

Management of postintubation membranous tracheal rupture

BACKGROUND: Postintubation tracheobronchial laceration is a rare complication of general anesthesia. A renewed interest in this disorder induced us to review our experience on its treatment, focusing on the evolution of the surgical approach, and describing a technical variation of the transcervical approach. METHODS: From January 1994 to December 2002 we treated 13 patients with diagnosis of postintubation tracheobronchial laceration. The treatment was nonsurgical in 3 patients (1-cm-long tear) and surgical in the other cases. Two lesions extending to the main bronchi were repaired through a right thoracotomy as well as four lesions limited to the trachea observed before January 2001. After this date we used the transcervical approach for entirely intratracheal lesions: in three cases we performed an anterior transverse tracheotomy and in one case a transverse and midline vertical incision (T tracheotomy). RESULTS: Both conservative and surgical therapy were successful in all the cases. Two patients in the thoracotomy group had a transient right vocal cord palsy. No morbidity was observed with the cervical approach. Normal healing of the sutures was evidenced by an endoscopic follow-up 30 days later. CONCLUSIONS: In our experience nonsurgical treatment is advisable in small (length < 2 cm) uncomplicated tears. Concerning surgery, thoracotomy is indicated in tracheal lacerations extending to the main bronchi, whereas the transcervical approach is preferred for intratracheal tears because of its efficacy in reaching and suturing the lesions extending to the carina and for its limited invasiveness.     

Trans-sternal approach to intraspinal tumours in the upper thoracic region

Summary The surgical management of ventrally located intraspinal tumours is often difficult, particularly in the upper thoracic region. The anterior approach to these tumours is hindered by anatomical structures.We report our experience using the trans-sternal approach. Three patients with intraspinal tumour between T1 and T4 underwent this approach. The surgical technique, the clinical presentation, the radiological features and the results are presented     

The extended deltoid-splitting approach to the proximal humerus

The recent technological developments in implant design and the wider availability of bone graft substitutes have stimulated a renaissance in the operative treatment of complex proximal humeral fractures. However, one of the remaining problems of the operative treatment of these injuries has been the limited surgical access to the posterior aspect of the shoulder afforded by the deltopectoral approach. In this article, we describe a novel extended deltoid-splitting approach, in which the area traversed by the axillary nerve is identified and protected during the surgery. We feel that this approach provides enhanced surgical exposure and offers a useful alternative to the deltopectoral approach in the operative treatment of 3- and 4-part proximal humeral fractures.     

Successful video-assisted mediastinoscopic drainage of descending necrotizing mediastinitis

Descending necrotizing mediastinitis is an uncommon form of mediastinitis that can rapidly progress to septacemia. To date, the optimal surgical approach has remained controversial. We report a case of descending necrotizing mediastinitis that was treated successfully through a transcervical approach with video-assisted mediastinoscopy. In our case, because the abscess was separated into small compartments, especially in the paratracheal space, the abscess was drained using video-assisted mediastinoscopy. This less-invasive approach may be an option in the treatment of descending necrotizing mediastinitis, especially when the abscess in the paratracheal space is separated into small compartments.     

Surgical treatment of patent ductus arteriosus (PDA) through mini subaxillary extrapleural approach.

In this study, a new surgical technique for the surgical treatment of patent ductus arteriosus (PDA) is evaluated. The subaxillary extrapleural approach was performed on 836 patients with patent ductus arteriosus. And 20 of these patients were evaluated for postoperative outcomes compared with the routine technique. The results indicated that the new method is safe, less traumatic and has better cosmetic effects. It is concluded in this article that the subaxillary extrapleural approach for PDA is a good modification to the routine surgical technique, that is surgery through the posterolateral approach.     

Modified transmanubrial osteomuscular sparing approach for resection of T1 vertebral tumor.

We report a technical modification of the classic transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for the treatment of a T1 vertebral tumor. The goal of the surgical treatment for spinal tumors of the cervico-thoracic area is to excise the vertebral tumor, reconstruct the spinal column, and place an internal fixation device to achieve immediate stabilization. The procedure was necessary for treating a patient who presented with an invasion of T1 vertebral body by multiple myeloma with initial neurological symptoms of epidural spinal cord compression. This approach requires a multidisciplinary team, essentially composed by the thoracic surgeon, who performs the anatomical dissection of the cervico-thoracic area, and the neurosurgeon, who performs the vertebrectomy and placement of a titanium prosthesis (Harm's cage). The operation was successful; the follow-up 6 months after the surgical procedure is normal.     

两种手术入路治疗老年肱骨近端骨折的疗效比较

[目的]比较肩峰下前外侧"T"型切口入路与三角肌胸大肌间隙入路治疗老年肱骨近端骨折的疗效.[方法]2005年1月～2009年6月间分别采用两种不同手术入路结合锁定钢板治疗老年肱骨近端骨折共65例.肩峰下前外侧"T"型切口入路组31例,年龄60～84岁(平均71岁),按Neer分类2部分骨折11例,3部分骨折巧例,4部分骨折5例;三角肌胸大肌间隙入路组34例,年龄60～81岁(平均70岁),按Neer分类2部分骨折9例,3部分骨折18例,4部分骨折7例.比较两组手术时间、出血量、末次随访时肩关节Constant评分.[结果]所有患者均获随访,随访时间12～24个月(平均16个月),骨折均愈合.肩峰下前外侧"T"型切口入路组手术时间及出血量明显少于三角肌胸大肌间隙入路组(P<0.01),而两组患者术后患侧肩关节功能无统计学意义上的差异(P>0.05).[结论]肩峰下前外侧"T"型切口入路结合锁定钢板治疗肱骨近端骨折具有功能恢复好、对局部及全身损伤小的特点,特别适合于老年患者的治疗,但必须熟悉局部解剖并且掌握合适的手术指征.     

Complex reconstructive surgery of cervico-urethral sclerosis after radical prostatectomy, due to endoscopic solution failure

The sclerosis of the cervico-urethral union is one of the complications that may arise after a radical prostatectomy, in most cases, the endoscopic treatment usually solves it. We introduce repair by open approach of a sclerosis cervico-urethral after radical prostatectomy that did not respond to endoscopic management. The surgical technique had two times, the first perineal and a second time with hypogastric approach. After six months of this complex surgery an artificial sphincter was placed to patient. The patient is asymptomatic and continent after three years of follow up surgery.     

Multiple endokrine Neoplasie Typ 1

Primary hyperparathyroidism (pHPT) occurs in about 90% of patients with multiple endocrine neoplasia type 1 (MEN1). In contrast to sporadic pHPT, multiple gland disease is most common in MEN1. The appropriate surgical approach is still controversial. The aim of this study was to analyze the results of surgical therapy of pHPT in patients with genetically confirmed MEN1. In an observational study, preoperative data, operative procedures, long-term results, and a possible genotype-phenotype correlation were analyzed in patients with pHPT and genetically confirmed MEN1. According to our results, tPTX+T (total parathyroidectomy+thymectomy+autotransplantation) seems to be a more favorable surgical approach in patients with MEN1 pHPT than sDE (selective gland exstirpation) and stPTX (subtotal parathyroidectromy) without cervical thymectomy, because recurrences or persistence of the disease are rare. A prospective randomized trial is needed to compare stPTX including cervical thymectomy vs tPTX+T. A genotype-phenotype correlation could not be identified.     

A Curative Resection Improves the Postoperative Survival Rate Even in Patients with Advanced Gallbladder Carcinoma

The aim of this study was to evaluate the results of our series of 90 operations for gallbladder carcinoma according to the Japanese Society of Biliary Surgery (JSBS) classification system and to clarify the appropriate surgical strategy for advanced gallbladder carcinoma based on the depth of primary tumor invasion and lymph node metastasis. Generally, only a surgical resection can achieve a prognostic improvement of the advanced gallbladder carcinoma. The survival of patients with this neoplasm depends strictly on the depth of histological primary tumor invasion and lymph node metastasis. A retrospective analysis was conducted on 90 patients from 1990 to 2004 who underwent a surgical resection of gallbladder carcinoma. The factors influencing survival were examined. Thirty-nine patients with palliative treatment (not resected cases), which was diagnosed as T3 or T4 by preoperative imagings, were also included in this study. The significance of the variables for survival was examined by the Kaplan-Meier method and the log-rank test followed by multivariate analyses using Cox's proportional hazard model. Portal invasion, lymph node metastasis, the surgical margin (+ vs. -) and the final curability (fCurA, B vs. C) were all found to be independent prognostic factors in the multivariate analysis. In pT2 gallbladder carcinoma, a better survival was achieved in an aggressive surgical approach, in order of a S4a+S5 hepatic resection, an extended cholecystectomy and a cholecystectomy. In pT3 and pT4, although radical extended surgery did not provide the opportunity for good survival even after lobectomy of the liver, the survival of patients with curative surgery was statistically better than in those without curative surgery. In addition, the nodal involvement of pN1 to pN2 was better than that with pN3. A S4a+S5 hepatectomy, therefore, appears to be adequate for the treatment of pT2 gallbladder carcinoma. Even in patients with pT3 and pT4 gallbladder carcinoma, long-term survival can be expected by an operation with a tumor-free surgical margin. The role of radical surgery, however, is considered to be limited in patients with pN3 lymph node metastasis.     

Endoscopic carpal tunnel release using the subligamentous two-portal technique

The surgical treatment for entrapment neuropathy of the median nerve in the carpal tunnel is varied. Recent publications have demonstrated a closed, endoscopic method for release of the carpal tunnel using a two-portal technique. In this report, a surgical technique for performing a subligamentous modification of this two-portal procedure is discussed, and the special tools used in this approach are demonstrated. In the early portion of this series of 75 symptomatic hands in 65 patients, 8% (6/75 hands) developed transient postoperative ulnar nerve neuropraxia. One patient experienced an iatrogenic laceration of the median nerve. Following the institution of the subligamentous approach, no postoperative nerve complications occurred. The majority of the patients experienced a significant decrease in their median nerve symptoms. This procedure has been found to be safe and is equally as effective as open surgical treatment of patients with carpal tunnel syndrome.     

Intraoperative neuromonitoring in thoracoscopic excision of brachial plexus schwannoma

Mediastinal schwannoma arising from brachial plexus are rare, but their surgical treatment could be challenging with a minimally invasive approach, given their position. Furthermore, their proximity to brachial plexus nerve fibres raises the risk for postoperative upper limb deficits. A 72-year-old man presented mediastinal schwannoma arising from the T1 nerve root. Complete surgical excision was achieved via video-assisted thoracic surgery with the aid of intraoperative neuromonitoring, and no postoperative neurological deficit developed after the intervention. Using intraoperative neuromonitoring, radical minimally invasive surgical treatment can be safely achieved for mediastinal schwannoma arising from brachial plexus.