Chemonucleolysis: advantages and disadvantages

The authors report their experience with 60 patients treated for lumbar disc herniation by chemonucleolysis with chymopapain and followed-up 1 to 3 years after treatment. Long-term results were as follows: excellent: 50%; good: 40%; fair: 8.2%; poor: 1.8%. The high percentage of positive results is attributed to the rigid criteria for patient selection used, which resulted in treatment by chemonucleolysis in only 18.6% of the surgical cases of lumbar disc pathology observed. 27.2% of the patients treated complained of disorders which resulted in postoperative complications and/or prolonged convalescence: prolonged low back pain and vertebral stiffness in 20%, persistent contralateral sciatic pain in 5.4%; intense but transitory worsening of the sciatica in 1.8%. The most feared complication of chemonucleolysis is paraplegia occurring after the inadverted injection of the enzyme into the spinal fluid. This risk overshadows the positive attributes of the method. The most important advantage of chemonucleolysis, as compared with surgery, is that it avoids epidural scarring and permanent postoperative anatomical changes. Patients may benefit from these advantages, but they must be willing to accept the negative aspects of the method, as well.     

Blood cardioplegia: advantages and disadvantages

Blood cardioplegia is worldwilde used during cardiac surgery. It provides a safe myocardial protection during this surgery. All along the year blood cardioplegia has been improved but it's of importance to apply it correctly. This can be a disadvantage during some cardiac surgery technics.     

Doxorubicin-induced canine CHF: advantages and disadvantages

BACKGROUND: The dog is the most commonly used laboratory animal for heart surgery research. It has been difficult, however, to develop a canine chronic heart failure model, particularly without associated significant tachycardia. Our objective is to utilize intracoronary doxorubicin at various doses to evaluate a chronic model of left ventricular dysfunction and develop a dose-response relationship. METHODS: In 18 dogs, we evaluated their hemodynamic function, placed an in-dwelling intracoronary catheter, and then administered four weekly infusions of doxorubicin at 5 mg (n = 6), 10 mg (n = 6), or 15 mg (n = 6). Hemodynamic measurements were taken again at 4-5 weeks after infusion, and a final measurement at 14-18 weeks. RESULTS (See table): In the low dose group, all six animals survived the post-infusion period. Cardiac output changed from 2.9 +/- 0.2 to 2.2 +/- 0.5. The medium dose group had a mortality of 33% (2/6 dogs), with a moderate decrease in cardiac output (3.1 +/- 0.4 to 2.3 +/- 0.3 L/min). The high dose group had a mortality of 67% (4/6 dogs), with a dramatic decrease in cardiac output (3.0 +/- 0.2 L/min to 1.6 +/- 0.7 L/min (p < 0.05). None of the dogs developed a significant tachycardia. CONCLUSION: This study reconfirms that doxorubicin, when given into the coronary arteries, induces cardiac dysfunction. It appears to be dose-dependent, but more importantly, in doses where the LV dysfunction yields overt heart failure; the mortality over 14 weeks is significant and likely unacceptable for most chronic heart failure studies.     

Eversion carotid endarterectomy: advantages and disadvantages

A comparative analysis of results of 70 operations fulfilled by the method of classical with autovein plasty of the internal carotid artery (ICA) and of 103 operations by the method of eversion carotid endarterectomy (CEAE) was made. The time of compression of the carotid artery during the eversion CEAE proved to be considerably less (22.5 +/- 6.5) min, than when using the "classical" method (32.5 +/- 5.3) min. In the nearest postoperative period no neurological complications of embologenic genesis or those associated with acute thrombosis of ICA after the eversion CEAE were noted while after the "classical" method they developed in 3 patients and 2 of them died. After the eversion CEAE 1 patients died of myocardial infarction. In remote periods after the "classical" CEAE the restenosis and reocclusions appeared in 6 patients, while after the eversion method--in 3 patients. CEAE fulfilled by the eversion technique is an effective operation reducing the amount of postoperative neurological complications as well as of late restenosis and reocclusions. It can be used without the applying of the internal bypass.     

Dialyzer reuse--part II: advantages and disadvantages

Although single dialyzer use and reuse by chemical reprocessing are both associated with some complications, there is no definitive advantage to either in this respect. Some complications occur mainly at the first use of a dialyzer: a new cellophane or cuprophane membrane may activate the complement system, or a noxious agent may be introduced to the dialyzer during production or generated during storage. These agents may not be completely removed during the routine rinsing procedure. The reuse of dialyzers is associated with environmental contamination, allergic reactions, residual chemical infusion (rebound release), inadequate concentration of disinfectants, and pyrogen reactions. Bleach used during reprocessing causes a progressive increase in dialyzer permeability to larger molecules, including albumin. Reprocessing methods without the use of bleach are associated with progressive decreases in membrane permeability, particularly to larger molecules. Most comparative studies have not shown differences in mortality between centers reusing and those not reusing dialyzers, however, the largest cluster of dialysis-related deaths occurred with single-use dialyzers due to the presence of perfluorohydrocarbon introduced during the manufacturing process and not completely removed during preparation of the dialyzers before the dialysis procedure. The cost savings associated with reuse is substantial, especially with more expensive, high-flux synthetic membrane dialyzers. With reuse, some dialysis centers can afford to utilize more efficient dialyzers that are more expensive; consequently they provide a higher dose of dialysis and reduce mortality. Some studies have shown minimally higher morbidity with chemical reuse, depending on the method. Waste disposal is definitely decreased with the reuse of dialyzers, thus environmental impacts are lessened, particularly if reprocessing is done by heat disinfection. It is safe to predict that dialyzer reuse in dialysis centers will continue because it also saves money for the providers. Saving both time for the patient and money for the provider were the main motivations to design a new machine for daily home hemodialysis. The machine, developed in the 1990s, cleans and heat disinfects the dialyzer and lines in situ so they do not need to be changed for a month. In contrast, reuse of dialyzers in home hemodialysis patients treated with other hemodialysis machines is becoming less popular and is almost extinct.     

Vascular mapping techniques: advantages and disadvantages

At present, an arteriovenous fistula is the best available access when compared with an arteriovenous graft or a tunneled hemodialysis catheter. Preoperative vascular mapping has been shown to result in an increased placement of arteriovenous fistulae. In general, 3 modalities (physical examination, ultrasound examination and angiographic evaluation) are available for vascular evaluation. Both arterial as well as venous examination can be conducted using physical examination. However, this technique is known to miss veins, especially in the obese, and result in exclusion of patients who do not show adequate veins on clinical inspection, but who have suitable veins (proven by the other modalities) for AVF construction. Ultrasound examination of the vessels is an objective assessment. It provides an excellent evaluation of both arteries and veins for creation of an arteriovenous fistula. The technique is limited by its inability to directly visualize the central veins. Although imaging of the veins by the administration of radiocontrast dye optimally visualizes peripheral as well as central veins, it exposes the patient to the risk of radiocontrast-induced nephropathy. This article presents advantages and disadvantages of the 3 mapping techniques and proposes a strategy to conduct vascular mapping in patients with chronic kidney disease.     

Hyperthyroidism: advantages and disadvantages of medical therapy

The most common causes of hyperthyroidism are Graves' disease, toxic nodular goiter, and iodine-induced hyperthyroidism. Hyperthyroidism can be treated medically with antithyroid drugs or radioactive iodine, or surgically. Multiple clinical factors must be weighed when choosing a treatment modality. All of the available forms of therapy have advantages and disadvantages, and treatment choices must be individualized.     

Gallstones: advantages and disadvantages of five treatment alternatives

Cholecystectomy is the gold standard treatment for symptomatic gallstones. However, within the last decade peroral drug chemolysis, methyl-tert-butyl ether lavage, shock wave lithotripsy, and percutaneous cholecystolithotomy have been introduced. This article compares and contrasts the presently available therapeutic modalities for gallstones and highlights the limitations of each treatment option.     

腹腔镜解剖性肝切除的利与弊

腹腔镜肝切除已被广泛应用于各种肝脏良恶性疾病的治疗和活体供肝的切取,其优势日益受到认可。腹腔镜解剖性肝切除与非解剖性肝切除的区别在于前者预先解剖和阻断预切除肝脏的入肝和(或)出肝血流,从而使得控制出血效果更优,断肝更加安全,可降低术中出血和气体栓塞风险、减少术后并发症,还可以降低肝癌术后复发率,可望提高肝癌的疗效;但也存在学习曲线长、肝切缘定位困难等弊端。腹腔镜肝切除时究竟选择解剖性切除还是非解剖性切除目前尚存争议。本文结合国内外文献就腹腔镜解剖性肝切除的利弊做一综述。     

A silicone implant filled with cohesive gel: advantages and disadvantages

This article presents our experience with an anatomically-shaped implant, which is filled with a special cohesive silicone gel. From 1993 through 1996, 132 women underwent breast augmentation. The indications were simple aplasia/hypoplasia (40), unsatisfatory appearance of previous prosthesis (58), and post-mastectomy deformity of the breast (34). Results and complications are reviewed. The findings suggest that this type of implant is safe and achieves satisfactory results in breast augmentation. Received: 7 February 1997 / Accepted: 20 April 1998     

Oncologic surgery: the advantages and disadvantages of minimally invasive surgery

For the last 15 years, the minimalized traumatization of laparoscopic surgical procedures has changed the treatment of numerous diseases. As a result, the method has also become an interesting therapeutic alternative for oncological indications, too. Nevertheless, its use in the special field of oncology, in particular when applied in curative intent, continues to give rise to controversial discussion. This paper takes a look at the potential advantages and disadvantages of the laparoscopic modality with regard to immune function and staging laparoscopy. In view of the fact that, at the present time, curative resections are being carried out in relevant numbers, in particular in the field of colorectal surgery, the technical feasibility, oncological radicality and oncological long-term outcomes are discussed on the basis of the data reported in the relevant literature on laparoscopic colorectal surgery.