Urgent pulmonary interventions in early childhood

The article deals with life threatening anomalies oft he lung in newborns which can only be cured by urgent surgical intervention. The clinical symptomatology is characterized in nearly all cases by intrathoracic displacement of healthy lung tissue. Own observations in connection with literature are dealt with.     

Minimally invasive therapy of the cystic-transformed thyroidal nodes]

The possibility of the miniinvasive methods application in the treatment of a cystic-transformed nodes of thyroid gland was studied up. In 59 patients the diagnostical and therapeutical interventions were carried out: in 39--the node's liquid contents aspiration (in 2 patients while cytological investigation the malignant transformation was revealed with operative treatment recommended); in 19--the ethanol sclerosing therapy (in 14--single, in 5--two-stage according to original method); in 4--the laser photocoagulation. The above mentioned methods efficacy was 82.2, 92.8 100 and 100% accordingly.     

Urgent surgery in colon carcinoma

INTRODUCTION: About 10% of all operations in colon carcinoma are performed in emergency situations because of severe preoperative complications. PATIENTS AND METHOD: The prospectively collected data of 1496 patients with colon carcinoma treated from 1987 to 2002 at the Department of Surgery of the University of Erlangen were analysed with special interest on postoperative morbidity and long-term prognosis after elective and urgent surgery. RESULTS: The rate of urgent surgery was 11%. The most frequent complication was bowel obstruction (73%) followed by perforation (20%). Emergency patients were significantly older (p<0.001) and in worse general condition (p<0.001). The rates of surgical and nonsurgical postoperative complications were higher in urgent surgery than in elective surgery (28.8% vs. 19.8%, p=0.015) and also postoperative mortality was significantly higher (10.1% vs. 4.0%, p<0.001). The rates of locoregioanal recurrences and distant metastases were significantly higher. Urgent surgery was found to be an independent prognostic factor for distant metastasis (relative risk 1.8) and cancer-related survival (relative risk 1.6). DISCUSSION: Urgent surgery in colon carcinoma is usually performed in advanced tumours of elderly patients. This operation can be a challenge for the treating surgeon. Adequate medical emergency supply needs to provide an experienced surgeon for those interventions.     

Simulation of minimally invasive vascular interventions for training purposes.

OBJECTIVE: To master the skills required to perform minimally invasive vascular interventions, proper training is essential. A computer simulation environment has been developed to provide such training. The simulation is based on an algorithm specifically developed to simulate the motion of a guide wire--the main instrument used during these interventions--in the human vasculature. In this paper, the design and model of the computer simulation environment is described and first results obtained with phantom and patient data are presented. MATERIALS AND METHODS: To simulate minimally invasive vascular interventions, a discrete representation of a guide wire is used which allows modeling of guide wires with different physical properties. An algorithm for simulating the propagation of a guide wire within a vascular system, on the basis of the principle of minimization of energy, has been developed. Both longitudinal translation and rotation are incorporated as possibilities for manipulating the guide wire. The simulation is based on quasi-static mechanics. Two types of energy are introduced: internal energy related to the bending of the guide wire, and external energy resulting from the elastic deformation of the vessel wall. RESULTS: A series of experiments were performed on phantom and patient data. Simulation results are qualitatively compared with 3D rotational angiography data. CONCLUSIONS: The results indicate plausible behavior of the simulation.     

Outcomes of breast-conservation therapy for invasive lobular carcinoma are equivalent to those for invasive ductal carcinoma

BACKGROUND: Breast-conservation therapy (BCT), including wide local excision and postoperative irradiation, is considered standard treatment for early-stage invasive ductal carcinoma (IDC). The use of BCT in patients with invasive lobular carcinoma (ILC) has been questioned because of concerns regarding ipsilateral breast recurrence and risk of bilateral breast cancer. We evaluated our institutional experience with BCT and compared treatment outcomes for ILC with those for IDC. METHODS: A review of our BCT database revealed 84 patients with ILC and 1,126 with IDC with stage I or II disease treated with BCT and radiation between 1976 and 1999. We evaluated local-regional recurrence, disease-specific survival, and contralateral breast cancer rates in both groups. RESULTS: The 5- and 10-year local-regional recurrence rates for the ILC group were 1% and 7%, respectively, and 4% and 9%, respectively, for the IDC group (P = .70). There were no significant differences in the 5- and 10-year disease-specific survival rates between the groups. Contralateral breast cancer occurred in 11.3% of patients with IDC and 11.9% of patients with ILC. CONCLUSIONS: BCT achieves similar local-regional control and survival outcomes in selected patients with ILC or IDC. Breast-conservation therapy is an appropriate treatment strategy for patients with early-stage invasive lobular carcinoma.     

Urgent heart surgery for an atrial mass: metastatic hepatocellular carcinoma

Extension of metastatic hepatocellular carcinoma into the right atrium is exceedingly rare and has a very poor prognosis. We report a case of successful surgical excision of hepatic tumor extension into the right atrium that was causing hemodynamic compromise.     

以分期为基础的食管癌微创治疗

随着食管癌分期手段及内镜、腔镜设备的不断发展，更准确的治疗前分期及更成熟的外科微创技术．为以分期为基础的食管癌微创治疗提供了可靠的保障。对不同分期的食管癌患者应当采用不同的微创治疗手段．在保证治疗效果的前提下．进一步减少创伤．加快患者康复．提高患者生活质量。     

Ultrasound-controlled minimally invasive surgical interventions in abdominal abscesses

Results of ultrasound-controlled minimally invasive surgical interventions (UAMISI) for abdominal abscesses are analyzed. 84 operations were performed in 72 patients with good results. Puncture method was used in 12 patients, drainage operation--in 58, endoscopy-guided puncture method--in 2 patients. Indications for different ultrasonic-assisted interventions are developed. It is concluded that at present the UAMISI are the alternative to conventional "open" treatment of abdominal abscesses.     

Minimally invasive interventions in solitary liver cysts]

Large intrahepatic cysts need surgical intervention when becoming symptomatic. In case of non-parasitic solitary cysts different surgical treatments are available. We performed three different minimal-invasive procedures in 8 patients. Good results were obtained by laparoscopic extended deroofing of the cyst. Indications and technical performance are presented.     

Minimally invasive interventions for concurrent diseases of extrahepatic biliary ducts and pancreas

The results of treatment of 689 patients with calculous cholecystitis and of 12 with cholecystogenic acute pancreatitis (AP), to whom laparoscopic interventions were performed, are adduced. In 50 patients the indexes of operative stress were studied up. The laparoscopic cholecystectomy efficacy was established in patients with cholecystogenic AP in the absence of obturational jaundice.     

A dilemma: prophylaxis for pulmonary embolism after surgical or invasive interventions for hemodialysis

AIM: This study was designed to investigate if it needs to do prophylaxis for pulmonary embolism in the patients treated with different kinds of dialysis or not, and if it is, to find a proper method for prophylaxis. METHODS: Ten numbers of patients with central venous catheters (CVC group), 13 numbers of patients with arteriovenous fistula (AVF group) were enrolled in this study. Eleven patients treated with peritoneal dialysis (PD group) were utilized as a control group. Clinical and laboratory examinations to exclude pulmonary embolism were carried out in both AVF and PD groups at the onset and after three months. Same examinations were performed in CVC group at the onset and after 3 weeks (mean: 21 days). Examinations to exclude pulmonary embolism consist of medical history, clinical examinations, d-dimer measures, chest x-ray, respiratory function tests, blood gas analyses, ventilation-perfusion scintigraphies. RESULTS: Neither clinical nor laboratory findings in any stages reflected any suspicion for pulmonary embolism. None of the patients in any groups was admitted with pulmonary embolism in any period of follow-up. There was not any statistically difference between the outcomes of all first examinations and of all second ones (P>0.005). Neither obvious nor subclinical pulmonary embolism was detected in any case. None of the patients had deep venous thrombosis in any stage of follow-up. CONCLUSIONS: Conventional techniques of haemodialysis do not lead to pulmonary embolism unless deep venous thrombosis due to any intervention occurs in the patients. Thus, prophylactic anticoagulant usage to prevent pulmonary embolism is not necessary in haemodialysis patients. To shorten the length of stay of central venous catheters is the most important factors for pulmonary embolism prophylaxis in haemodialysis patients.     

乳腺浸润性导管/小叶混合癌与浸润性小叶癌、导管癌的临床病理特征及预后差异

目的 研究乳腺浸润性导管/小叶混合癌(infiltrative ductal/lobular mixed carcinoma,IDC-L)与浸润性小叶癌(infiltrative lobular carcinoma,ILC)及浸润性导管癌(infiltrative ductal carcinoma,IDC)病理特征及预...     

Morbidity of inguinal lymphadenectomy for invasive penile carcinoma

OBJECTIVE: To determine the incidence and the consequences of complications related to modified and radical inguinal lymphadenectomy in patients with invasive penile carcinoma, defined by invasion of the corpus spongiosum or cavernosum (> or =T2). MATERIALS AND METHODS: A total of 118 modified (67.0%), and 58 radical (33.0%) inguinal lymphadenectomy were performed in 88 patients between 1989 and 2000. To decrease the morbidity, radical inguinal lymphadenectomy was proposed only in patients with palpable inguinal lymph nodes, uni- or bilaterally (N1 or N2). Modified inguinal lymphadenectomy was performed bilaterally in patients with invasive penile carcinoma and non-palpable inguinal lymph nodes (N0), and unilaterally in the side without inguinal metastases in N1 patients. Complications were assessed retrospectively with a median follow-up of 46 months and classified as early (event observed during the 30 days after the procedure) or late (event present after hospitalisation or after the first months). RESULTS: A total of 74 complications after 176 procedures were recorded. After modified inguinal lymphadenectomy, 8 early (6.8%) and 4 late (3.4%) complications were observed. There were a total of 110 dissections with no complications and 8 dissections with 1 or 2 complications. After radical inguinal lymphadenectomy, the morbidity increased with 24 early (41.4%) and 25 late (43.1%) complications, observed in only 18 of 58 radical procedures. Leg oedema was the most common late complication, interfering with ambulation in 13 cases (22.4%). CONCLUSION: Modified inguinal lymphadenectomy, with saphenous vein sparing and limited dissection offers excellent functional outcome in patients with invasive penile carcinoma and nonpalpable inguinal lymph nodes. The morbidity after radical lymphadenectomy still significant, especially in patients with multiple or bilateral superficial inguinal lymph nodes treated by pelvic and bilateral inguinal lymphadenectomy.     

微创技术治疗肝细胞癌的进展

Minimally invasive therapy is gaining increasing attention as an important part of therapies in hepatocellular carcinoma (HCC). It includes laparoseopic liver resection, transarterial therapy, local ablative therapy and some new extraeorporeal energy therapies. The theoretical advantages of laparoscopic liver resection are those of minimally invasive surgery in general, such as early recovery, shorter hospital stay, and better cosmetic outcome. However, laparoseopie liver resection for HCC is still considered as controversial because of the uncertainty of the long-term results, and fear of compromising the principles of oncologic resection. Transarterial chemoembolization is the most promising palliative medality for uuresectable HCC, but other techniques, such as transarterial radioembolization and local ablative therapy, have also shown promising results. Recent evidence suggests that local ablative therapy may offer comparable survival outcomes in patients with small HCC and preserved liver function when compared with partial hepatectomy. This article focuses on the development in minimally invasire therapy of HCC.     

Minimally invasive fetoscopic interventions: an overview in 2010

Background  

The availability of high-end endoscopic equipment, microcatheters, miniballoons, tiny laser fibers, and other devices has been instrumental in the development of minimally invasive fetoscopic interventions. These interventions are performed for a spectrum of fetal disease states that progress in severity over the course of gestation and have a huge impact on termination of pregnancy rates, fetal demise, perinatal mortality and morbidity, and long-term prognosis. This report aims to introduce interested readers to these new procedures.