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1.
Yasunori FUJIMOTO Henrique F. RAMOS Pedro P. MARIANI Fabrizio R. ROMANO Arthur CUKIERT Edson BOR-SENG-SHU Akatsuki WAKAYAMA Toshiki YOSHIMINE 《Neurologia medico-chirurgica》2015,55(4):345-350
We describe a practical technique of superior turbinectomy followed by posterior ethmoidectomy as a less invasive procedure for two-surgeon technique on endoscopic endonasal transsphenoidal surgery. After identification of the superior turbinate and the sphenoid ostium, the inferior third portion of the superior turbinate was coagulated and resected. This partial superior turbinectomy procedure exposed the posterior ethmoidal sinus. Resection of the bony walls between the sphenoid and posterior ethmoid sinuses provided more lateral and superior exposure of the sphenoid sinus. This technique was performed in 56 patients with midline skull base lesions, including 49 pituitary adenomas and 7 other lesions. Meticulous manipulation of instruments was performed in all cases without surgical complications such as permanent hyposmia/anosmia or nasal bleeding. Our findings suggested that the partial superior turbinectomy followed by retrograde posterior ethmoidectomy is a simple and safe technique providing a sufficient surgical corridor for two-surgeon technique to approaching midline skull base regions, mainly involving pituitary adenomas. 相似文献
2.
Porterfield JR Thompson GB Young WF Chow JT Fryrear RS van Heerden JA Farley DR Atkinson JL Meyer FB Abboud CF Nippoldt TB Natt N Erickson D Vella A Carpenter PC Richards M Carney JA Larson D Schleck C Churchward M Grant CS 《World journal of surgery》2008,32(5):659-677
Background Cushing’s syndrome (CS), due to multiple etiologies, is a disorder associated with the ravages of cortisol excess. The purpose
of this review article is to provide a historical synopsis of surgery for CS, review a recent 10-year period of operative
management at a tertiary care facility, and to outline a practical approach to diagnosis and management.
Materials and Methods From 1996 to 2005, 298 patients underwent 322 operative procedures for CS at Mayo Clinic, Rochester, Minnesota. A retrospective
chart review was carried out. Data was gathered regarding demographics, preoperative assessment, procedures performed, and
outcomes. Data are presented as counts and percentages. Five-year survival rates were calculated where applicable by the Kaplan-Meier
method. Statistical analysis was carried out with SAS, version 9 (SAS Institute, Inc., Cary, NC).
Results Two-hundred thirty-one patients (78%) had ACTH-dependent CS and 67 patients (22%) had ACTH-independent CS. One-hundred ninety-six
patients (66%) had pituitary-dependent CS and 35 patients (12%) had ectopic ACTH syndrome. Fifty-four patients (18%) had cortisol-secreting
adenomas, 10 patients (3%) had cortisol-producing adrenocortical carcinomas, and 1% had other causes. Cure rates for first
time pituitary operations (transsphenoidal, sublabial, and endonasal) were 80% and 55% for reoperations. Most benign adrenal
processes could be managed laparoscopically. Five-year survival rates (all causes) were 90%, 51%, and 23% for adrenocortical
adenomas, ectopic ACTH syndrome, and adrenocortical carcinomas, respectively.
Conclusions Surgery for CS is highly successful for pituitary-dependent CS and most ACTH-independent adrenal causes. Bilateral total adrenalectomy
can also provide effective palliation from the ravages of hypercortisolism in patients with ectopic ACTH syndrome and for
those who have failed transsphenoidal surgery. Unfortunately, to date, adrenocortical carcinomas are rarely cured. Future
successes with this disease will likely depend on a better understanding of tumor biology, more effective adjuvant therapies
and earlier detection. Clearly, IPSS, advances in cross-sectional imaging, along with developments in transsphenoidal and
laparoscopic surgery, have had the greatest impact on today’s management of the complex patient with CS. 相似文献
3.
Background: Hybrid, combined or mixed bariatric surgery is the combination of a degree of ‘malabsorption’ (as achieved by the intestinal bypass) with a ‘rrestriction’
(as achieved by gastric bypass or gastroplasty), thereby simultaneously reducing the absorption of fats in the small bowel
and decreasing the intake of food. Methods: A modification of the bilio-pancreatic diversion (BPD) with a duodenal switch
procedure, vertical lineal gastrectomy and preservation of the pylorus, has been used in 23 patients. The antropyloric pump
and 4 cm of the duodenum are left intact to preserve physiologic gastric emptying and to prevent anastomotic ulcer. The use
of staplers and continuous running sutures reduces surgical risks and operative time. Results: One patient, converted from
a vertical gastroplasty, had an intrathoracic esophageal perforation and died of multisystemic organ failure, a mortality
rate of 4.5%. One patient had a partial dehiscence of the laparotomy wound. Three patients developed subcutaneous seromas.
Mean weight losses during the first 4 months were 13, 11, 6 and 5 kg, with a loss of 70% of excess weight in patients approaching
1 year. No patient needs treatment for diarrhea. No serious secondary side-effects have been detected. Conclusion: This operation
appears to result in very satisfactory weight loss, improved quality of life, and a low incidence of complications. 相似文献
4.
Valenzuela Cristian D. Levine Edward A. Mangieri Christopher W. Gawdi Rohin Moaven Omeed Russell Gregory Lundy Megan E. Perry Kathleen C. Votanopoulos Konstantinos I. Shen Perry 《Annals of surgical oncology》2022,29(6):3448-3449
Annals of Surgical Oncology - 相似文献
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Yasukazu KAJITA Daisuke NAKATSUBO Hirotada KATAOKA Toshiya NAGAI Takahiro NAKURA Toshihiko WAKABAYASHI 《Neurologia medico-chirurgica》2015,55(12):907-914
The neuromate is a commercially available, image-guided robotic system for use in stereotactic surgery and is employed in Europe and North America. In June 2015, this device was approved in accordance with the Pharmaceutical Affairs Law in Japan. The neuromate can be specified to a wide range of stereotactic procedures in Japan. The stereotactic X-ray system, developed by a Japanese manufacturer, is normally attached to the operating table that provides lateral and anteroposterior images to verify the positions of the recording electrodes. The neuromate is designed to be used with the patient in the supine position on a flat operating table. In Japan, deep brain stimulation surgery is widely performed with the patient''s head positioned upward so as to minimize cerebrospinal fluid leakage. The robot base where the patient''s head is fixed has an adaptation for a tilted head position (by 25 degrees) to accommodate the operating table at proper angle to hold the patient''s upper body. After these modifications, the accuracy of neuromate localization was examined on a computed tomography phantom preparation, showing that the root mean square error was 0.12 ± 0.10 mm. In our hospital, robotic surgeries, such as those using the Da Vinci system or neuromate, require operative guidelines directed by the Medical Risk Management Office and Biomedical Research and Innovation Office. These guidelines include directions for use, procedural manuals, and training courses. 相似文献
7.
Surgery of Colorectal Cancer: Surgical Morbidity and Five- and
Ten-Year Results in 2400 Patients—Monoinstitutional Experience 总被引:4,自引:0,他引:4
The objective of this study was to determine surgical morbidity and long-term outcome of colorectal cancer surgery for quality control reasons and as the basis for new treatment modalities. Surgically treated colorectal cancer patients (mean age 65 years) were followed prospectively in a university center (110 months mean follow-up, 1978-1999). Overall survival (OAS), radicality, extent of resection, recurrence, and morbidity were analyzed (log-rank test of survival, multivariate analysis). Altogether, 2452 colorectal cancers localized in the colon (CC, 44.6%), rectum (RC, 44.8%) or multicentric (CRC, 10.6%) were of UICC stages I (19%), II (30%), III (21%), IV (20%), or undetermined (10%). Radicality and stage but not tumor localization influenced the OAS (p <0.0001). The 5-year/10-year OASs were 50%/42% (all), 78%/66% (R0), 46%/36% (R1), 4%/0% (R2), 0% (unresected) and 86%/79% (I), 70%/58% (II), 42%/33% (III), 3%/0% (IV) or 21%/12% (undetermined), respectively (p <0.0001). Multivisceral resections (17%) resulted in morbidity and survival rates equal to those for standard resection. The overall tumor recurrence rate was 27%, mainly with both local and distant relapse (15%). Surgery-related complications occurred in 18% (all), 14% (CC), 21% (RC), or 20% (CRC). The perineal infection rate (RC) was 4%, overall anastomotic leakage 1%, and mortality rate 0.8%. A prospective, uniform follow-up used over two decades warrants quality control in colorectal cancer surgery, which was curative for half of the patients. The morbidity and mortality were low and were not increased by multivisceral resections. 相似文献
8.
It is generally agreed that neonates with necrotizing enterocolitis (NEC) and pneumoperitoneum should be treated surgically.
We report herein the case of a 3-day-old male newborn with NEC in whom a pneumoperitoneum subsequently developed without any
cause found at laparotomy. This case is presented to discuss the nonsurgical management of pneumoperitoneum in selected patients.
Received: December 13, 1999 / Accepted: September 26, 2000 相似文献
9.
Satoru SHIMIZU Takahiro MOCHIZUKI Shigeyuki OSAWA Toshihiro KUMABE 《Neurologia medico-chirurgica》2015,55(9):761-765
After the drainage of chronic subdural hematomas (CSDHs), residual isolated deep-seated hematomas (IDHs) may recur. We introduce intraoperative ultrasonography to detect and remove such IDHs. Intra-operative ultrasonography is performed with fine transducers introduced via burr holes. Images obtained before dural opening show the CSDHs, hyper- and/or hypoechoic content, and mono- or multilayers. Images are also acquired after irrigation of the hematoma under the dura. Floating hyperechoic spots (cavitations) on the brain cortex created by irrigation confirm the release of all hematoma layers; areas without spots represent IDHs. Their overlying thin membranes are fenestrated with a dural hook for irrigation. Ultrasonographs were evaluated in 43 CSDHs (37 patients); 9 (21%) required IDH fenestration. On computed tomography scans, 17 were homogeneous-, 6 were laminar-, 16 were separated-, and 4 were trabecular type lesions. Of these, 2 (11.8%), 3 (50%), 4 (25%), and 0, respectively, manifested IDHs requiring fenestration. There were no technique-related complications. Patients subjected to IDH fenestration had lower recurrence rates (11.1% vs. 50%, p = 0.095) and required significantly less time for brain re-expansion (mean 3.78 ± 1.62 vs. 18 ± 5.54 weeks, p = 0.0009) than did 6 patients whose IDHs remained after 48 conventional irrigation and drainage procedures. Intraoperative ultrasonography in patients with CSDHs facilitates the safe release of hidden IDHs. It can be expected to reduce the risk of postoperative hematoma recurrence and to shorten the brain re-expansion time. 相似文献
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Learning Objectives: The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to:
- 1.Define the changes in the practice of breast implant surgery that followed the FDA hearings on silicone gel-filled breast implants.
- 2.Characterize the expected life span of breast implant devices, which can be predicted from historical data.
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Khan UD 《Aesthetic plastic surgery》2012,36(2):303-307
Background
Mastopexy with or without augmentation is a commonly performed procedure. Marking, orientation of the flap and, in simultaneous augmentation, pockets for the implants can be selected in any combination. Vertical scar mastopexy, with or without augmentation, is commonly performed, with a high revision rate for skin redundancy. A new technique called the “cat’s tail” extension of the vertical scar is a simple modification developed to avoid this complication. 相似文献15.
Mikolaj Walensi Samuel A. Käser Panagiotis Theodorou Gabrio Bassotti Gieri Cathomas Christoph A. Maurer 《World journal of surgery》2014,38(2):505-511
Objective
Transanal endoscopic microsurgery (TEM) is an established method for the resection of benign and early malignant rectal lesions. Very recently, TEM via an anally inserted single incision laparoscopic surgery (SILS®)-port has been proposed to overcome remaining obstacles of the classical TEM equipment.Methods
Nine patients with a total of 12 benign or early stage malignant rectal polyps were operated using the SILS®-port for TEM. Patients’ and polyps’ characteristics, perioperative and postoperative complications, as well as operating and hospitalization time were recorded.Results
All 12 polyps (ten low-grade adenoma, one high-grade adenoma, one pT2 carcinoma [preoperatively staged as T1]) were resected. Local full-thickness bowel wall resection was performed for three lesions and submucosal resection for nine lesions. Median operating time was 64 (range 30–180) min. No conversion to laparoscopic or open techniques was necessary. The median maximum diameter of the specimen was 25 (range 3–60) mm, fragmentation of polyps was avoidable in 11 of 12 (92 %) lesions, and resection margins were histologically clear in 11 of 12 (92 %) polyps. Only one patient, in whom three lesions were resected, experienced a complication as postoperative hemorrhage. No mortality occurred. Median hospitalization time was four (range 1–14) days.Conclusions
SILS®-TEM is a feasible and safe method, providing numerous advantages in application, handling, and economy compared with the classical TEM technique. SILS®-TEM might become a promising alternative to classical TEM. Randomized, controlled trials comparing safety and efficacy of both instrumental settings will be needed in the future. 相似文献16.
Lalit Aggarwal Swati Sattavan Romesh Lal Deborshi Sharma Saurabh Borgharia Nishit Shrivastava Rama Alagappan Ranvir Singh 《The Indian journal of surgery》2017,79(4):349-353
Short bowel syndrome (SBS), one of the commonest types of intestinal failure, usually secondary to extensive bowel resection, traditionally has been associated with a high mortality rate and hence a big challenge for the treating surgeons. It requires comprehensive clinical care to minimise the morbidities and mortality associated with the condition. We report a retrospective review of a series of seven patients with SBS, who presented at our surgical emergency within a period of 1 year and their outcome so as to encourage others in managing such a challenge with more positive mindsets. A retrospective analysis of seven patients with SBS admitted from January 2014 to January 2015 with a follow-up of 1 year has been done in terms of their demographic characteristics, underlying pathology and clinical outcome. A rising incidence of SBS in the younger age group (71.4%) has been observed in this analysis. Majority of patients (57.1%) had mesenteric ischemia as the underlying cause followed by each case of small bowel volvulus, internal herniation and blunt trauma abdomen. A discharge rate of 71.4% and mortality rate of 28.5% were observed. With this analysis, we believe that SBS is no more an uncommon condition. A structured clinical approach, timely surgical intervention and multidisciplinary postoperative management are essential for managing such frail patients to achieve best possible results. This will encourage others in managing such a critically challenged condition with a more positive approach and thus beneficial for both the patients and the treating surgeon. 相似文献
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Terence C. Chua BScMed Tristan D. Yan PhD Michelle E. Smigielski Katherine J. Zhu MBBS Keh M. Ng MBBS Jing Zhao MD David L. Morris MD 《Annals of surgical oncology》2009,16(7):1903-1911
Background Cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) has been recognized as a treatment option
for pseudomyxoma peritonei. This study reports the survival outcomes, clinicopathological prognostic factors, and a learning
curve from a single institution’s experience.
Methods Patients with pseudomyxoma peritonei underwent CRS and PIC, which was comprised of hyperthermic intraperitoneal chemotherapy
(HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC), according to a standardized treatment protocol in
our institution. Clinicopathological factors were analyzed to determine their prognostic value for survival using univariate
and multivariate analysis. Time period comparison was performed to study the effect of a learning curve.
Results A total of 106 patients (43 men and 63 women) were treated. The mortality rate was 3% and severe morbidity rate was 49%.
The median follow-up was 23 (range, 0–140) months. The overall median survival was 104 months with a 5-year survival rate
of 75%. The progression-free survival was 40 months with a 1-year progression-free survival rate of 71%. Factors influencing
survival include histopathological type of tumor, use of both HIPEC and EPIC, peritoneal cancer index, completeness of cytoreduction,
and severe morbidity. The results demonstrate a learning curve where patients with a higher peritoneal cancer index (PCI)
were treated, reduced amount of blood products required, more patients undergoing HIPEC and the combined HIPEC and EPIC, more
redo-procedures performed, and a longer progression-free survival.
Conclusions This report demonstrates long-term survival outcomes, acceptable perioperative outcomes, and a learning curve associated
with the treatment of patients with pseudomyxoma peritonei. 相似文献
19.
Tomecek FJ 《The spine journal》2011,11(11):1024-1026
Commentary on: Kim CH, Chung CK, Jahng T-A, Kim HJ. Resumption of ambulatory status after surgery for nonambulatory patients with epidural spinal metastasis. Spine J 2011; 11:1015-23 (in this issue). 相似文献
20.
Background The purpose of this study was to compare computed tomography (CT) cholecystography and ultrasound for gallstone detection
in preoperative bariatric surgery patients.
Methods The study included 16 asymptomatic prebariatric surgery patients. On the same day, each patient underwent abdominal CT 4 h
after IV cholecystograffin injection, and gallbladder ultrasound. CT and ultrasounds were reviewed by two independent, blinded
radiologists, and scored as follows: no gallstones, possible gallstones, definite gallstones, indeterminate. CT and ultrasound
results were compared.
Results Ultrasound detected definite gallstones in three patients, possible gallstones in one patient, and no gallstones in ten patients.
Two scans were considered indeterminate. CT cholecystography detected definite gallstones in six patients, possible gallstones
in zero patients, and no gallstones in nine patients, and was indeterminate in one patient. All three patients with gallstones
seen sonographically had definite gallstones on CT. The patient with possible gallstones detected sonographically had definite
stones detected at CT. One of the two patients with indeterminate ultrasounds had gallstones detected at CT. The other patient
had both studies indeterminate. One patient with no gallstones sonographically had definite gallstones at CT. No patients
with a negative CT had gallstones seen on ultrasound. Nine patients had no gallstones on either modality.
Conclusions CT cholecystography is more sensitive and specific for the detection of gallstones in the obese population. CT cholecystography
should be considered in place of ultrasound in the preoperative workup of these patients. 相似文献