Pathologic assessment of the surgical specimen

Despite the wealth of information obtained by conventional histology, long-term studies are needed to provide novel information on the correlation of pathologic findings with prognosis. Findings need to be correlated not only with PSA progression but with the more clinically important parameters of distant metastases and survival. Although conventional histology still will have a role in the evaluation of prostate cancer at radical prostatectomy and its correlation with outcome, it undoubtedly will be augmented by newer techniques. These developments must be approached critically and rationally to determine whether they provide additional prognostic information beyond that currently available using more conventional parameters.     

Pathologic scars: an overview of surgical strategies

In most cases pathologic scars are managed using surgical procedures. In recent decades a trend towards the generalized use of flaps has been observed. Skin expanders have been applied for a while and are still useful in postburn alopecia. Large surfaces are being treated more and more with skin substitutes. These are mainly dermal substitutes covered with partial thickness skin grafts. These procedures can be combined in order to cover very large skin surfaces. Prefabricated flaps are based on angiogenesis induction via vessel carriers implanted in the depth of the skin structure. The use of skin substitutes limits skin harvesting, which may be a source of scarring.     

Evaluation of surgical treatment outcome in epilepsy

Seven recent papers are reviewed for outcomes following epilepsy surgery. The criteria of outcome assessment are analyzed and compared. All studies agree in indicating that the combination of the classic evaluation of seizure frequency with that of quality of life is required for a comprehensive view of the surgical outcome. However, the assessment modalities and outcome scales proposed present relevant differences. The need for standardization is apparent. A surgical outcome scoring system using multiple measures is recommended. The outcome evaluation should be performed not sooner than 2 years after surgery. The most relevant of the many variables of the outcome should be selected in such a way as to permit assessment of the epileptological response to surgery as well as the changes in the quality of life.     

Pathologic acetabular fractures: new concepts in surgical management

Pathologic fracture of the pelvis and acetabulum secondary to metastases is a disabling condition for cancer patients. Management has for the most part remained nonoperative because the complexities of pelvic anatomy and reconstruction yield risks which have outweighed potential benefits. No advances in surgical reconstruction have been reported in one and a half decades. Previous reports and ideas addressing surgical reconstruction have focused on which type of total hip arthroplasty best suits the acetabular bone stock remaining following removal of the tumor. As improving medical management of metastatic cancer increases longevity, improved methods for surgical management of pathologic fractures are required. A new concept for surgically managing periacetabular fractures due to metastases is introduced whose premise is based on pelvic rather than hip pathology. Resection of tumor-infiltrated acetabular columns creates reconstructive challenges best met by the techniques and knowledge gained from trauma surgeons repairing acetabular fractures. The additional use of reinforced polymethylmethacrylate and subchondral bone cement augments fixation. These concepts have been incorporated into a new classification system and treatment strategy which is critically examined in 13 individuals. Tumor resection and pelvic-periacetabular reconstruction can satisfactorily be performed through extensile pelvic approaches without necessarily performing a hip arthroplasty. A more complete oncologic resection, superior reconstruction, and quicker rehabilitation for affected individuals can result in approximately one half of individuals.     

Pathologic prognostic factors for gastrointestinal cancer

Numerous clinicopathologic factors have been reported to have prognostic significance for gastrointestinal cancer. Many problems, however, confront the surgeon assessing the extent of disease and the clinical and molecular pathologist distinguishing differences in tumor differentiation, behavior, and defining important prognostic markers of cancer. This review assesses current pathologic prognostic variables of gastric and colorectal cancer that have been reported to influence survival.

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Resumen Aunque numerosos factores clinicopathológicos han sido reportados como de impacto significativo en cuanto a pronóstico en el cáncer gastrointestinal, son muchos los problemas que debe confrontar el cirujano en lo relativo a determinar la extensión de la enfermedad, así como el patólogo clínico y molecular referente a la variada diferenciación tumoral, comportamiento y, también, la definición de marcadores de pronóstico. En el presente artículo se revisan y evalúan les variables patológicas de pronóstico en el cáncer gástrico y colorrectal, que, se han informado, tienen influencias sobre la supervivencia.

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Résumé De nombreux facteurs clinicopathologiques des cancers digestifs ont été corrélés avec une signification pronostique. Le chirurgien rencontre cependant beaucoup de difficultés pour évaluer correctement l'étendue de la maladie, alors que l'anatomopathologiste clinique et moléculaire a des difficultés pour évaluer le degré de différentiation, le comportement tumoral et pour définir les facteurs pronostiques du cancer. Cette revue évalue les paramètres pronostiques anatomopathologiques dans le cancer gastrique et colorectal pour lesquels une signification pronostique sur la survie a été retrouvée.

     

Preoperative investigation of the surgical patient

Perioperative risk can be minimized through the identification, assessment and optimization of co-morbidities. This article considers the role of preoperative investigation, with reference to current anaesthetic and surgical guidelines, in both the reduction of patient risk and improvement of perioperative outcome.     

圆锥隔心室型室间隔缺损的病理解剖和外科纠治

目的 分析单纯圆锥隔心室型室间隔缺损的病理解剖,探讨其外科纠治.方法 回顾1999年4月到2005年4月手术纠治50例单纯圆锥隔心室型室间隔缺损病儿病历资料,其中后下缘肌性26例,主动脉瓣和三尖瓣纤维连接24例.结果 术后无Ⅲ度房室传导阻滞发生.2例因VSD前上缘残余分流（0.4 cm,0.3 cm）,再次修补.11例有较明显的流出道肌束肥厚,完全或部分离断.2例体外循环停止后食管超声提示流出道肌束肥厚,压差分别为35 mm Hg、40 mm Hg,再次手术离断.随访5例有轻度右室流出道梗阻;三尖瓣中度反流1例,轻度5例,轻微5例.2例心包积液,1例术后出血.结论 提出圆锥隔心室型VSD的定义,规范其病理解剖和外科纠治会进一步精确室间隔缺损的诊治.     

Focal cooling devices for the surgical treatment of epilepsy

Focal cooling may provide a safe, nondestructive alternative to resective and disconnective strategies that have been proposed or used to control refractory epilepsy. Observations of the effects of direct application of iced saline on the cortical surface during cortical mapping surgery and induced seizures have led to interest in developing implantable cooling therapy devices for refractory localizable epilepsies. In this article, the authors provide an overview of the historical background, physiology, and animal and human data leading to the development of implantable cooling devices for the treatment of medically refractory epilepsy.     

Temporal lobotomy in the surgical management of epilepsy: technical report

OBJECTIVE: To describe the technique of temporal lobotomy and demonstrate that it may produce results equivalent to anterior temporal lobectomy in the control of drug-resistant complex partial seizures of anterior temporal lobe origin. METHODS: Patient selection and evaluation was similar to that for other patients undergoing anterior temporal lobectomy, with the exception that the 10 selected patients all demonstrated extensive lobar or hemispheral atrophy on magnetic resonance imaging or computed tomographic scans. The lobotomy technique involved posterior and superior disconnection, each of which was broken down into lateral and mesial components. RESULTS: At last follow-up, seven patients were seizure-free, one had rare seizures, and two had a less than 90% decrease in seizures. These outcomes are similar to those in our overall temporal lobectomy series. One patient who underwent left-sided temporal lobotomy had a speech fluency deficit postoperatively. CONCLUSION: Temporal lobotomy seems to be an effective disconnective procedure in the treatment of drug-resistant temporal lobe epilepsy. Larger series will be needed to better define its role in the management of this condition.     

Psychosocial adjustment after epilepsy surgical treatment

Epilepsy is a matter of interest to several medical specialities: neurology, neurosurgery, pathology, psychiatry, and other fields of knowledge such as psychology and sociology. Although a high prevalence of psychopathological disorders is often reported among epileptic patients who are candidates for neurosurgery, this cannot explain the problems that may be experienced by patients after surgery. Numerous related aspects such as neurological, psychological and sociological factors cause disturbances. This study suggests that systematic psychological and social management might help in the transition from chronic disability to wellness by means of improved adjustment potential.     

难治性癫痫外科治疗现状

癫痫是许多发展中国家较常见的神经系统疾病,其中约20％～25％患者经抗癫痫药物治疗无效而需手术治疗。事实表明,精确的致痫灶定位可以提高手术的成功率,早期有效的外科治疗不仅使患者癫痫发作消失或频率减少,且能显著改善患者生活质量。本文就难治性癫痫的术前评估及外科治疗方法做一综述。     

The surgical treatment of intractable epilepsy.

The author reviewed the various surgical approaches for intractable epilepsy and proposes that any surgical operation for the treatment of intractable epilepsy be performed actively but prudently. It is important to identify the operation indication and to use combinations of anterior callosotomy, epileptogenic focus resection and multiple subpial transection (MST), tailored to the individual patient. Selective temporal lobe removal can also provide a fairly good result in temporal lobe seizures. For epileptogenic foci in functional areas, MST was an effective approach that protected neural function and blocked epileptic discharge. For epileptogenic foci in the free-functional areas, however, epileptogenic focus resection was still the best therapy. Hemisphere removal should be chosen cautiously and only for patients with intractable epilepsy with progressive neurological deficits in the hemisphere. The author notes that using minimally invasive neurosurgery techniques to treat epilepsy and to protect neural function will become more widely recommended.     

多处软脑膜下横切术治疗顽固性癫痫

目的提高顽固性癫痫手术疗效。方法对１９９１年１月至１９９６年１２月实施多处软脑膜下横切除（ＭＳＴ）的１１６例患者的发作类型、病因及手术方法进行分析。结果随访１～５年者１００例,发作完全控制６２例,发作减少７５％以上２０例,发作减少５０％以上１２例（占１２％）,无变化６例。总有效率为９４％,显效率８２％,未发现任何功能损害。结论ＭＳＴ治疗顽固性癫痫十分有效,可替代某些传统的痫灶切除术;双额叶ＭＳＴ配合胼胝体前部切开术可作为治疗全身性顽固性癫痫的尝试性手段;手术方法的改良可明显提高手术效果并减少并发症的产生;对于远离功能区的器质性病变应尽量予以切除。     

The results of the surgical treatment of occipital lobe epilepsy

Summary Out of 502 patients with surgically treated drug-resistant chronic epilepsy (tumour cases excluded) in 12 (2%) a clear occipital focus was found. The pattern of seizures was in most cases nonspecific and polymorphic. EEG examination and neuroradiological findings led to proper localization of the epileptogenic focus. Partial or total occipital lobectomy was performed. Follow-up from 4 to 20 years revealed a satisfactory result in 11 of the surgical cases. One patient was lost to follow-up. Brain scarring was found in the histological examination of specimens in 9 out of 12 patents. The results of the surgical treatment of occipital lobe epilepsy are much better than in other localizations of epileptogenic foci.