Surgical Management of Resistant Priapism

We report a 31 year old patient, presented with painful erection since 48 hours. There was no known predisposing factor on history and examination. Surgery for priapism is rarely indicated nowadays but conservative management failed to achieve detumescence in our case. So Winter’s shunt surgery was done which failed then a formal shunt was created between corpora cavernosa and spongiosum which also failed to achieve detumescence. After 4 days - a formal left side cavernosa saphenous shunt procedure was done and detumescence achieved within 24 hrs .Follow up showed good results.     

Esophageal Perforation: Principles of Diagnosis and Surgical Management

PURPOSE: Esophageal perforation (EP) is still associated with a high mortality rate, even after surgical repair. We reviewed 17 cases of EP to evaluate the management of this major surgical problem. METHODS: We reviewed the medical records of all patients treated for EP in our department between November 2001 and November 2004. Therapy was based on various patient-related factors. RESULTS: Seventeen patients, with a mean age of 63 years, presented with EP mostly caused by iatrogenic incidents (11/17). In nine patients, the perforation was located in the thoracic segment, with a mean size of 2.5 +/- 0.6 cm. Thoracic computed tomography (CT) was performed in all patients to assess the periesophageal inflammation precisely. More than 50% showed signs of systemic inflammation indicative of sepsis, reflected by a dramatic increase in serum C-reactive protein and leukocytosis. Treatment consisted of debridement and drainage (n = 3), primary repair (n = 3), reinforced repair (n = 4), esophageal resection (n = 5), and conservative measures (n = 2). All patients, except for three with pre-existing liver dysfunction and other comorbidities, survived, representing a mortality rate of 17.6% (14/17). An analysis of the literature (2000-2005) revealed an overall mortality rate of 19.7% (101/521), ranging from 3% to 67%. CONCLUSION: Our data support the individualized surgical management of EP, based on careful evaluation of various patient-related factors, including CT findings.     

Surgical Management of Haemophilic Pseudotumors: Experience in a Developing Country

Aim: Hemophilic pseudotumors result from repeated episodes of bleeding into bone, subperiosteum, and soft tissue. Since clotting factors became available, uncontrolled perioperative bleeding is a less significant problem for surgeons in developed countries. However, they are more difficult to come by in China. Additionally, patients often have to undergo surgery for giant masses and suffer complications. We wanted to present our experience in the surgical management of hemophilic pseudotumors over a 40-year period. Methods: We retrospectively reviewed 429 hemorrhagic coagulopathy patients between 1983 and 2015. Diagnosis of hemophilic pseudotumor was confirmed following clinical, radiological, and pathological criteria. The data were recorded and analyzed: type and severity of hemophilia, presence of inhibitor, etiological antecedent, localization of pseudotumors, clinical signs, surgical management and outcomes. Results: Eighteen pseudotumor patients underwent surgical treatment. All of them were male, with mean age of 34.3 years. Fifteen patients had hemophilia A and three patients had hemophilia B. There were twelve proximal and two distal pseudotumor patients. The mean follow-up was 51.9 months. For pseudotumors in the extremities, complete surgical resection was achieved. For four patients with pelvic or abdominal pseudotumors, complete surgical resection was only achieved in two patients because of preventing potential vital organs injuries. Delayed healing of the incision, allergic reactions, and ureteral injury were the major complications. Conclusion: Surgery is an alternative method with safety and efficacy. Careful and individual treatment is required by the hematologist, orthopedic surgeon and other members of the team who collaborate and participate in hemophilic surgery.     

Surgical Management for Diabetic Foot Ulcer: A Bibliometric Study

BackgroundManagement of patients with diabetic foot ulcer is often burdensome, complex, and arduous. In addition, it can be challenging for clinicians and researchers to understand the surgical management of diabetic foot ulcer from the existing studies because of the extensive literature on this topic.MethodsBibliometric analysis was conducted using CiteSpace, and data were retrieved from the Web of Science Core Collection.ResultsA total of 1,475 publications were retrieved. The “United States Department of Health and Human Services (HHS, USA)” and “National Institutes of Health (NIH, USA)” were the most important funders. The most active authors were Armstrong DG and Lipsky BA. The most active institutions were the University of Washington and University of Arizona. Developed countries in the USA and England contributed the most to the literature, and the publications were clustered into 15 topics. The emerging topic trend was the cluster label for “diabetic foot osteomyelitis” and “multidisciplinary setting”.ConclusionsThis study provides researchers and clinicians with important information on the cooperation of authors, institutions, and countries, intellectual structure, knowledge flow, and emerging topic trend, to help them with their subject cognition, study visits, study abroad, research direction selection, and grant applications.     

Inflammatory Pseudotumor of the Temporal Bone: A Case Series

Inflammatory pseudotumor is a non-neoplastic inflammatory process. Histologically these lesions appear as an inflammatory infiltrate with a fibrotic background. Clinical presentations vary from slow growth with minimal mass effect, to bony destruction that can mimic malignancy. Although they occur most commonly in the orbit, there are a growing number of case reports of tumors of the temporal bone and skull base. Inflammatory pseudotumors of the temporal bone are best treated by excision, with radiation and steroid therapy reserved for inoperable tumors. The clinical, histologic, and radiographic features of two patients with inflammatory pseudotumor of the temporal bone are presented.     

慢性胰腺炎的外科治疗

目的 改善慢性胰腺炎的外科治疗效果。方法 回顾性分析我院外科1983－2000年收治的34例慢性胰腺炎病人的临床资料，并将其分为慢性钙化性胰腺炎及慢性梗阻性胰腺炎两组。结果 男性23例（68％），女性11例（32％），平均年龄52.89岁。嗜酒者23例（67.65%），合并胆石症者13例（38.24%），继往有急性胰腺炎发作者11例（32.35%）。主诉腹痛者28例（82.35%），合并黄疸者17例（50％），慢性钙化性胰腺炎与慢性梗阻性胰腺炎在某些临床表现间存在显著性差异，提示二者可能存在不同的发病机制。34 病人分别采用9种不同的手术方式，无围手术期死亡。Puestow手术及胰十二指肠切除可有效地缓解疼痛，并可改善胰外分泌功能，对胰内分泌的影响不大。Puestow手术并行胆肠吻合适于合并胆道狭窄的慢性胰腺炎病人，而仅行胆道引流效果不佳。结论 慢性胰腺炎的外科治疗应采用个体化原则，如合并胰管扩张可行Puestow引流手术，胰头炎性包块病人应行切除手术。     

Surgical Management of Substernal Goiters: Clinical Experience of 170 Cases

Purpose To discuss the presentation, diagnosis, treatment, histopathological findings, and complications of patients who underwent thyroidectomy for substernal goiter in our surgical clinic.Methods We retrospectively analyzed 170 patients with substernal goiters among 2650 patients undergoing surgical treatment for various thyroid diseases between 1990 and 2003. We evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications.Results The most common symptoms were a cervical mass (88%) and dyspnea (35%), but 26% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 77% of the patients. We performed total or near total thyroidectomy and operated through a cervical incision in all but 12 of the patients. There was no operative mortality but 12 (7%) patients suffered temporary hypoparathyroidism and 4 suffered transient vocal cord paralysis (2%). Malignancy was diagnosed by histopathological examination in 22 (13%) patients.Conclusion We think that the diagnosis of a substernal goiter is an indication for thyroidectomy, which is associated with very low postoperative morbidity.     

Acute Surgical Unit: a new model of care

The traditional on‐call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant‐driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24‐h period of on‐call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU. The ASU has a day team with two registrars, two residents and a nurse practitioner. All patients are admitted and stay in the ASU until discharge or transfer to other units. Handover of the patients at the end of each day is facilitated by a comprehensive ASU database. The implementation of the ASU at Nepean Hospital has improved the timing of assessment by the surgical unit. There has been significant improvement in the timing of operative management, with an increased number and proportion of cases being done during daylight hours, with an associated reduction in the proportion of cases performed afterhours. There is greater trainee supervision with regard to patient assessment, management and operative procedures. There has been an improvement in the consultants' work conditions. The ASU provides an excellent training opportunity for surgical trainees, residents and interns in the assessment and management of acute surgical conditions.     

Surgical synovectomy of the knee in young haemophiliacs: long-term results of a monocentric series of 23 patients

Background  

In haemophiliacs, synovectomy is indicated for recurrent joint bleedings, despite medical treatment.     

埃布斯坦综合征的外科治疗

目的 为了改善埃布斯坦综合征（Ｅｂｓｔｅｉｎ ａｎｏｍａｌｙ）的手术疗效,总结３６例埃布斯坦综合征患者的手术治疗经验。方法 ３６例手术中,三尖瓣置换术６例,Ｄａｎｉｅｌｓｏｎ手术２８例,Ｃａｒｐｅｎｔｉｅｒ手术２全;其中５例同时行右心房室旁路切断术。结果 术后早期右侧心力衰竭死亡４例,其中心瓣膜置换术１例,成形术２例,１例成形术并右心房室旁路切断术死于右心室壁血肿。２５例患者随访３个月～１１年,１     

Cardiac Rhabdomyoma in the Neonate: Surgical Management

Rhabdomyoma is the most common cardiac neoplasm in neonates. Tuberous sclerosis is found in half of the patients with rhabdomyomas. We maintain a surgical policy of accepting for operation only neonates in whom it has been demonstrated that the primary cause for hemodynamic compromise is obstructing, intracavitary neoplasms. Only the intracavitary portions of the rhabdomyoma are excised; no effort is made to completely remove all intramural tumors.Rhabdomyomas demonstrate benign pathological characteristics and may regress. Neonates with rhabdomyomas but no hemodynamic impairment, or those in whom only intramural masses can be demonstrated, are not considered surgical candidates. Tuberous sclerosis by itself should not be judged a contraindication to operation. The results of our surgical policy regarding rhabdomyomas in neonates are reported in two case presentations.     

The Pediatric Surgical Team: a Model for Increased Surgeon Index Case Exposure

Background/PurposeHigh surgical volume for both surgeons and hospital systems has been linked to improved outcomes for many surgical problems, yet case volumes per pediatric surgeon are diminishing nationally in complex pediatric surgery. We therefore sought to review our experience in a geographically isolated setting where a surgical team approach has been used to improve per-surgeon exposure to index pediatric surgical cases.MethodsAs a surgical group, we incorporated a surgical team approach to complex pediatric surgical cases in 2010. We obtained institutional review board approval to review our pediatric surgeon index case volume experience. We then compared our surgeon experience to published surgical volumes for complex pediatric surgical cases.ResultsA surgical team approach (2 or 3 board certified pediatric surgeons/urologists working as co-surgeons or assistant surgeon) was used in the majority of cases for tracheoesophageal fistula/esophageal atresia (77%), congenital pulmonary airway malformation (73.5%), cloaca (75%), anorectal malformation (43.6%) biliary atresia (77.8%), Hirschsprung's disease (51.9%), congenital diaphragmatic hernia (67.6%), robotic choledochal cyst (100%), and complex oncology (adrenal tumors, neuroblastoma, Wilms tumor and Hepatoblastoma surgery) (85–100%). Over the 5-year period, surgeon index case exposure for all index pediatric surgical cases was above the published national median for pediatric surgeons, except for in splenic operations when contrasted to published experience.ConclusionsA surgical team approach to complex pediatric surgery may help maintain exposure to adequate index case volumes. This model may be useful for maintaining competence in geographically-isolated practice settings and low-volume pediatric hospitals that provide surgical care; the model has implications for systems development and workforce allocation within pediatric surgery.Level of Evidence4     

Surgical treatment result of giant thyroid tumor: Case series in Vietnam

IntroductionGiant thyroid tumors can be associated with severely compressive symptoms and surgery is inevitable for treatment strategy. However, the risk of surgical complications is higher as well as the duration of operation may be longer than those of small thyroid tumors.Presentation of casesTwo patients with large neck tumors were admitted with history of thyroid goiters for more than 10 years. Recently, the patients have complained of worsening compressive symptoms including dyspnea and dysphagia. Imaging work-up indicated a deviation and compression of trachea. Both patients underwent either lobectomy or thyroidectomy and were discharged without any complications. Final histological results were thyroid adenoma in both cases.ConclusionSurgical management is considered as primary treatment for most patients with giant thyroid tumors. It is necessary to be aware of complications and careful dissection to archive a good outcome.     

Surgical Management of Chronic Pancreatitis

Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.     

先天性主动脉瓣二叶化畸形的外科治疗

目的　探讨先天性主动脉瓣二叶化畸形的诊断、适宜手术时机、围术期处理以及手术疗效。　方法　 60例患者被施行心瓣膜置换术 ,行主动脉瓣机械瓣置换术 5 6例 ,行自体心包瓣置换术 4例 ;同时行主动脉窦瘤破裂修补术 2例 ,胸主动脉瘤修补术 2例 ,动脉导管未闭缝扎术 3例 ,室间隔缺损修补术 5例 ,冠状动脉旁路移植术 3例。其中伴感染性心内膜炎 2 5例。　结果　术后早期死亡 5例 ,死亡率为 8.3 %。随访 4 9例 ,平均随访时间 5 .4年 ,5年生存率为 84 .3 %。　结论　先天性主动脉瓣二叶化畸形以男性居多 ,左、右二叶型较前、后型常见 ,可致主动脉瓣关闭不全和 /或狭窄 ,以关闭不全多见 ( 75 % )。出现充血性心力衰竭、心绞痛、晕厥、感染性心内膜炎时应尽早行手术治疗 ,症状不明显的患者应定期复查超声心动图 ,主动脉瓣置换术是常用的手术方法。     

Surgical Treatment of a Superior Sulcus Tumor in a Patient with Idiopathic Thrombocytopenic Purpura: Report of a Case

We herein report a resection of a superior sulcus tumor in a patient with idiopathic thrombocytopenic purpura. A resection of the left upper lobe of the lung, left subclavian artery, and left first to third ribs, as well as a reconstruction of the left subclavian artery, were performed. Postoperative hemorrhaging was controlled due to preoperative high-dose intravenous immunoglobulin therapy and a platelet transfusion both during and following surgery. The resected tumor was diagnosed to be a pulmonary pleomorphic carcinoma, which was pathologically determined to be T3N0M0-Stage 2B. The patient remained in good condition for 20 months following the surgery; however, he eventually died due to bone metastases.