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1.
Background
Protection of the bronchial stump after pneumonectomy reduces the incidence of bronchopleural fistula. However, which technique provides the most satisfactory results remains open for debate.Materials and Methods
We describe a study in which a bronchial stump coverage technique was performed using 2 layers of human fibrin glue (Tissucol; Baxter, Deerfield, IL USA) with an interposed patch of parietal pleura. From July 2005 to June 2007, this technique was used in 31 consecutive patients after standard pneumonectomy by a single surgeon.Results
None of the patients developed early or late bronchopleural fistula, and no clinical adverse reaction was recorded. During the same period, alternative stump coverage techniques were used by different surgeons in 71 pneumonectomies. In this group, the rate of fistula was 6% (4 patients).Conclusion
These preliminary data demonstrate the feasibility of the technique and suggest that it is at least equivalent to the other type of flaps used. The main advantages of this technique are the restoration of the natural separation between the mediastinum and pleural cavities, as well as the reduced operating time (duration 5 minutes). 相似文献2.
Background
The purpose of this study was to provide information concerning the performance of selective transarterial chemoembolization (TACE) as a palliative treatment in patients with hepatocellular carcinoma (HCC), also in the case of multifocal lesions.Patients and methods
We reviewed prospectively collected data on 43 patients with cirrhosis and HCC who underwent selective TACE as a palliative treatment. Patients were assigned to one of two groups: (1) those with one to three HCC lesions, and (2) those with four or more HCC lesions.Results
One hundred and two TACE sessions were applied in 43 patients. There were 39 men and 4 women with a mean age of 65.5 ± 8.273 years. Alpha fetoprotein levels were elevated to a median value of 73.8 U/mL prior to first TACE (range, 1.5-25615 U/mL). Fourteen patients underwent one session, and 29 patients from two to eight TACE sessions. Bilobar HCC distribution prior to initial TACE was evident in 40% of the patients. Solitary HCC was radiologically diagnosed in 14 patients. Twenty-seven patients were assigned to group 1 and 16 patients to group 2. No significant differences were found between the two groups concerning the number of TACE sessions and the severity of liver cirrhosis. Currently 12 patients are alive after a median follow-up of 25 months (range, 3-84 months). Three- and 5-year survival rates according to patient groups were 45% and 19%, and 42% and 11% for the patients' groups 1 and 2, respectively (P = .87).Conclusions
HCC patients without a curative therapy option may benefit from palliative TACE, also in the case of multifocal lesions. 相似文献3.
Romeo E Foschia F de Angelis P Caldaro T Federici di Abriola G Gambitta R Buoni S Torroni F Pardi V Dall'oglio L 《Journal of pediatric surgery》2011,46(5):838-841
Background/Purpose
Congenital esophageal stenosis (CES) is a rare malformation. Endoscopic dilations represent a therapeutic option. This study retrospectively evaluated the efficacy and safety of a conservative treatment of CES.Patients and Methods
Patients diagnosed with CES since 1980 by a barium study or endoscopy were reviewed. Endoscopic ultrasonography (Olympus UM-3R-20-MHz radial miniprobe, Olympus Corporation, Tokyo, Japan), available from 2001, allowed for the differential diagnosis of tracheobronchial remnants (TBR) and fibromuscular hypertrophy (FMH) CES. All children underwent conservative treatment by endoscopic dilations (hydrostatic and Savary).Results
Forty-seven patients (20 men) had CES. Fifteen were associated with esophageal atresia; and 8, with Down syndrome. Mean age at the diagnosis was 28.3 months (range, 1 day to 146 months). Symptoms were solid food refusal, regurgitation, vomiting, and dysphagia. Congenital esophageal stenosis was located in the distal esophagus. Endoscopic ultrasonography demonstrated TBR and FMH in 6 patients. One hundred forty-eight dilations in 47 patients were performed. The stenosis healed in 45 (95.7%). Complications were 5 (10.6%) esophageal perforations, hydrostatic (3/32, or 9.3%), and Savary (2/116, or 1.7%). At follow-up, 1 patient with FMH CES and 1 patient with TBR CES required operation for persistent dysphagia.Conclusions
The conservative treatment yielded positive outcomes in CES. Endoscopic ultrasonography allows for a correct diagnosis of TBR/FMH CES. A surgical approach should be reserved for CES not responsive to dilations. 相似文献4.
Wiley Chung 《American journal of surgery》2009,197(5):604-608
Introduction
High transsphincteric fistulas are difficult to treat because fistulotomy of involved sphincter muscle results in incontinence. We compare our outcomes for anal fistula plug, fibrin glue, advancement flap closure, and seton drain insertion.Methods
This is a retrospective study of patients treated for high transsphincteric anal fistulas. The primary outcome was full healing at 12 weeks postoperatively.Results
Between 1997 and 2008, 232 patients with anal fistula were identified in the St. Paul's Hospital Anal Fistula Database. Postoperative healing rates at the 12-week follow-up for the fistula plug, fibrin glue, flap advancement, and seton drain groups were 59.3%, 39.1%, 60.4%, and 32.6%, respectively (P < .0001).Conclusions
Closure of the primary fistula opening using a biological anal fistula plug and anal flap advancement result in similar fistula healing rates in patients with high transsphincteric fistulae. These 2 strategies are superior to seton placement and fibrin glue. Given the low morbidity and relative simplicity of the procedure, the anal fistula plug is a viable alternative treatment for patients with high transsphincteric anal fistulas. 相似文献5.
Study Design
Randomized controlled clinical trial.Introduction
Manual edema mobilization (MEM) is a method of edema reduction based on the lymphatic system’s ability to drain and resolve subacute edema.Purpose of the Study
To investigate the effect of a modified MEM approach and compare it with a traditional edema technique in patients with subacute hand/arm edema after a distal radius fracture.Method
The patients were randomized into one of two treatment groups: a group that received traditional edema treatment and a group that received a modified MEM treatment. All patients were examined for edema, active range of motion (AROM), pain, and activities of daily living (ADL). The number of edema sessions and the number of all sessions were counted.Result
No statistically significant changes were observed in edema reduction, AROM, pain, and ADL at six and nine weeks between the treatment groups. A statistically significant improvement was observed in ADL after three weeks after inclusion (p = 0.03) in the modified MEM group compared with the control group. Furthermore, fewer edema treatment sessions were needed (p = 0.03) in the modified MEM group. At six weeks, we observed a difference between the two groups’ needs for further edema treatment (p = 0.04).Conclusion
Neither the traditional nor the modified MEM treatment program was superior in terms of edema reduction, although the modified MEM resulted in fewer sessions to decrease subacute hand/arm edema compared with using traditional edema reduction techniques in patients after distal radius fracture.Level of Evidence
1. 相似文献6.
Hackam DJ Reblock K Barksdale EM Redlinger R Lynch J Gaines BA 《Journal of pediatric surgery》2003,38(6):946-949
Background
Children with Down’s syndrome (DS) have a reportedly poorer outcome after treatment of Hirschsprung’s disease (HD) compared with control children. Because of overall improvements in their management, the authors hypothesized that the diagnosis of DS would not influence outcome after the management of HD.Methods
Consecutive children with HD (1995 through 2002) were collected prospectively then divided retrospectively into those with DS and controls (C). Patients who underwent surgery at another institution and those with total colonic aganglionosis were excluded.Results
Of 66 patients, 9 had DS. Mean age at diagnosis, gender, racial distribution, gestational age, and proximity to our center were similar between groups. Presenting symptoms, location of the transition zone, and type of initial operation were similar. Patients with DS had significantly more comorbidities than controls, which generated significantly greater treatment costs and a higher mortality rate. However, with an average of 22 months of follow-up, the overall outcome including postoperative complications, enterocolitis, and constipation was similar.Conclusions
These data suggest that in contrast to earlier reports, DS has minimal influence on surgical outcome of patients with HD. Although the overall cost of treating patients with DS is greater, this mainly reflects the impact of managing comorbidities. 相似文献7.
Michael Lieberth 《American journal of surgery》2009,197(3):418-423
Background
The purpose of this study was to assess our colorectal surgical training program experience with the Delorme procedure for complete rectal prolapse.Methods
Consecutive patients were identified from a surgical database and evaluated by chart review.Results
Seventy-six patients with a mean follow-up period of 3.6 years were included. Outcomes included a recurrence rate of 14.5%, an overall complication rate of 25%, and a surgical site-specific complication rate of 8%. For patients younger than 50 years old (mean age, 36 y; range, 19-49 y), the recurrence rate was 8% with a mean follow-up period of 4.1 years. Their total complication rate was 15%, with no surgery site-specific complications.Conclusions
Our results are consistent with previously published experiences in that most preoperative evacuatory symptoms resolve with repair of the prolapse, and serious complications are uncommon. The observation that recurrence and complication rates may be lower in younger medically fit patients suggests the Delorme repair need not be restricted specifically to older, medically unfit patients. 相似文献8.
Mulekar SV Issa AA Eisa AA 《Burns : journal of the International Society for Burn Injuries》2011,37(3):448-452
Introduction
Deep burns often result in hypo-pigmentation, referred to as leucoderma which has a similar psychosocial impact on the patients as that of vitiligo. Several tissue grafting methods have been reported to treat post-burn leucoderma.Methods
A simple method consisting of harvesting a donor skin sample, preparation of an epidermal cell suspension and the transplantation of the cell suspension on to a dermabraded recipient area, was performed in a clean procedure room. No special laboratory set-up was used for the cell separation procedure. Patients were treated with 18 sessions of excimer laser starting 1 month post-operatively, to hasten the repigmentation.Observation
Of the 10 patients treated with MKTP, 3 were lost to follow-up. The remaining 7 patients showed repigmentation ranging from 90% to 100% with good color matching.Conclusion
MKTP is an effective method to treat post-burn leucoderma. No special precautions are required to treat any anatomical site or uneven scarred surface. 相似文献9.
Leonardo Elías Ordóñez-Ordóñez Usmaila S. Navarro-García Esther Sofía Angulo-Martínez 《Otolaryngology--head and neck surgery》2010,143(1):60-65
Objective
To determine whether surgical section of attachment of the medial crural footplates to the quadrangular cartilage produces loosening of the nasal tip.Study Design
Prospective, observational, before-and-after study.Setting
Tertiary care center.Subjects and Methods
Hispanic patients undergoing septoplasty who required a transfixion incision were included. A six-month postoperative assessment of the nasal tip support was compared with preoperative values. As measures of the nasal tip support, we included tip recoil test, nasolabial angle, tip rotation angle, nasofacial angle, and the Goode method for determining tip projection.Results
Twenty-seven patients completed the follow-up, and their results are reported. There were no statistically significant differences after septoplasty in any of the five measurements used to assess the nasal tip support (P > 0.05).Conclusion
In this preliminary cohort of Hispanic patients, surgical section of the attachment of the medial crural footplates to the quadrangular cartilage does not produce significant changes in nasal tip support. 相似文献10.
Objective
To compare short- and long-term results of radiofrequency tonsillotomy and traditional cold dissection tonsillectomy in adult patients with recurrent tonsillitis.Study Design
A randomized clinical trial.Setting
A tertiary referral university hospital.Subjects and Methods
Of 62 adults with recurrent tonsillitis, 24 patients were treated with cold dissection tonsillectomy, while radiofrequency tonsillotomy (RF) by use of radiofrequency induced thermotherapy probes was performed in the remaining 38 patients. Duration of surgery, amount of intraoperative bleeding, recovery time, postsurgical pain (measured by use of visual analogue scale on days 1, 3, 5, and 10 after surgery), dysphagia, weight loss, and time of return to normal diet and activity were measured. All the patients were followed for 12 to 24 months for recurrence of tonsillitis episodes.Results
Comparing the radiofrequency tonsillotomy group to the cold dissection tonsillectomy group, mean duration of surgery was 16.89 versus 45.04 minutes, recovery time was 14.32 minutes versus 17.08 minutes, and amount of intraoperative bleeding was 15 to 20 cc versus 250 to 300 cc, respectively (P < 0.005). There was no difference between the two groups in the recurrence of tonsillitis episodes after 24 months.Conclusion
Tonsillotomy with radiofrequency is a simple, rapid, and effective method in adult patients with recurrent tonsillitis. 相似文献11.
Robert J. Tibesar Andrew R. Scott Christopher McNamara Timothy A. Lander James D. Sidman 《Otolaryngology--head and neck surgery》2010,143(1):90-96
Objective
To determine the long-term results of distraction osteogenesis of the mandible for upper airway obstruction in children with micrognathia.Study Design
Case series with chart review.Setting
Tertiary care children's hospital.Subjects and Methods
The records of a pediatric otolaryngology practice and tertiary children's hospital were searched for patients treated with bilateral mandibular distraction osteogenesis for upper airway obstruction. Patients were selected if greater than three years of follow-up data were available. Data were analyzed for airway and feeding outcomes, and long-term surgical complications were identified.Results
Thirty-two patients met study criteria. Of the 11 patients who had tracheotomy prior to distraction, seven were decannulated after the procedure. Seventeen patients needed perioperative gastrostomy. Seven are now able to feed orally. Fifteen patients treated with mandibular distraction were able to avoid gastrostomy tube placement altogether. The complication of open bite deformity was experienced by nine patients (28%). Five of 32 patients (16%) had tooth malformation, tooth loss, or dentigerous cyst formation while an additional three patients (9%) had long-term facial nerve injury. Nineteen patients (59%) were under three months old at the time of their distraction. Only one of these patients (5.2%) required an additional distraction procedure.Conclusion
Long-term follow-up data on patients treated with mandibular distraction for upper airway obstruction show sustained airway improvement. Additionally, micrognathic children treated with distraction have improved outcomes in oral feeding with a relatively low rate of long-term complications. It remains important to follow these patients to monitor the need for secondary reconstructive procedures. 相似文献12.
Salman AE Salman MA Saricaoglu F Akinci SB Aypar Ü 《Journal of clinical anesthesia》2011,23(4):270-274
Study Objective
To investigate whether methylene blue, given before injection of propofol, was effective in reducing the frequency and severity of pain associated with propofol injection.Design
Prospective, randomized, double-blinded clinical study.Setting
Operating room of a university hospital.Patients
90 adult, ASA physical status 1 and 2 patients undergoing elective surgery.Interventions
Patients were randomly allocated to one of three groups of 30 patients each. Group I received 50 mg of methylene blue, Group II received 40 mg of lidocaine, and Group III, the control group, was given normal saline. All drugs were given as a 2.0 mL bolus 45 seconds before propofol administration.Measurements
Injection pain using vocal responses, facial grimacing, arm withdrawal, tears, and questioning of the patient were noted. A 4-point scale was used for documenting pain.Main Results
Pain frequency was 90% in the saline group, whereas the frequencies were significantly lower in the lidocaine and methylene blue groups (26.7% and 40%, respectively).Conclusions
Intravenous pretreatment with methylene blue appears to be effective in reducing the pain during propofol injection. 相似文献13.
Arnell H Bergdahl S Papadogiannakis N Nemeth A Fischler B 《Journal of pediatric surgery》2008,43(7):1312-1320
Background
Patients with progressive familial intrahepatic cholestasis (PFIC) often require liver transplantation to survive. An alternative approach is surgical diversion of bile, that is, partial external biliary diversion (PEBD). The aim of the study was to describe 13 patients with PFIC who have undergone PEBD.Methods
Clinical and laboratory workups including growth data and histology specimens were analyzed to evaluate the short-term effects of PEBD. Follow-up, including liver biopsies, was performed 11 to 21 (median, 14) months post-PEBD.Results
All patients showed typical features of PFIC. Eight out of 13 presented with variable signs of coagulopathy, and one patient presented with hypocalcemic seizures. The surgery was uneventful in all, but 4 patients were readmitted because of dehydration and electrolyte imbalance caused by excessive stomal losses. One month post-PEBD, 7 patients were apruritic. One patient had stomal dysfunction, showed no improvement on cholestasis after surgery, and had to undergo liver transplantation 2 months post-PEBD. At follow-up, significant biochemical improvement and gains in growth were seen in most of the patients.Conclusions
Most of the patients with PFIC presented with signs of coagulopathy. Partial external biliary diversion had a dramatic effect on cholestasis and growth, although not all patients benefited from the surgery. Episodes of dehydration post-PEBD must be considered. 相似文献14.
Objective
The objective was to present a case series of pediatric patients presenting with small bowel obstruction secondary to both congenital and acquired internal mesocolic hernias, and the use of imaging technology in the management of this condition.Methods
A retrospective review of patients treated at the Yale-New Haven Children's Hospital for small bowel obstruction from 1998 to 2008 (n = 6) who presented with acute small bowel obstruction secondary to internal mesocolic hernias was performed.Results
We present 6 patients with small bowel obstruction caused by congenital (n = 4) and acquired (n = 2) mesocolic hernias after previous surgery. The median age at presentation was 13 years. Small bowel obstruction with a mesocolic hernia was identified by preoperative abdominal computerized tomography in 3 patients (50%) and at operation in the others. The mean length of stay was 6 days, with no recurrent episodes in the follow-up period.Conclusion
Small bowel obstruction secondary to mesocolic hernias, although rare, may be considered in the differential diagnosis of patients with history of malrotation or abdominal wall defects owing to their association with congenital mesenteric anomalies. This condition requires special attention from the clinician because of its catastrophic consequences. Imaging studies are an important asset because of the difficulty in making an accurate clinical diagnosis and the rarity of internal hernias. 相似文献15.
Mitsunobu Imasato 《American journal of surgery》2010,199(4):442-446
Background
Areolar injection for sentinel lymph node biopsy (SLNB) in breast cancer surgery has been adopted by many institutions. However, only one study has reported the follow-up results for patients whose SLNB was performed with this injection method alone.Methods
Three hundred eighty patients with breast cancer underwent SLNB with periareolar injection of both blue dye and radiotracer. The follow-up consisted of a physical examination every 3 months and annual mammography.Results
Of 380 patients with SLNB, 261 were found to have negative sentinel lymph nodes so that no ALND was performed. At a median follow-up of 39 months (range 13-74), 2 of the 261 patients developed axillary recurrence for an axillary relapse incidence of .77%. Five-year distant disease-free survival was 96.9%, and overall survival was 99.4%.Conclusions
The incidence of axillary recurrence for the areolar injection method was low and consistent with that reported in other observational studies using other injection methods. 相似文献16.
Puapong D Lee SL Haigh PI Kaminski A Liu IL Applebaum H 《Journal of pediatric surgery》2007,42(9):1500-1503
Background
This study evaluates outcomes for children treated without interval appendectomy (IA) after successful nonoperative management of perforated appendicitis.Methods
A retrospective study of pediatric patients with appendicitis was performed from 12 regional acute-care hospitals from 1992 to 2004 with mean length of follow-up of 7.5 years. Main outcomes were recurrent appendicitis and cumulative length of hospital stay.Results
The study included 6439 patients, of which 6367 (99%) underwent initial appendectomy. Seventy-two (1%) patients were initially managed nonoperatively and 11 patients had IA. Of the remaining 61 patients without IA, 5 (8%) developed recurrent appendicitis. Age, sex, type of appendicitis, and abscess drainage had no influence on recurrent appendicitis. Cumulative length of hospital stay was 6.6 days in patients without IA, 8.5 days in patients with IA, and 9.6 days in patients with recurrent appendicitis.Conclusion
Recurrent appendicitis is rare in pediatric patients after successful nonoperative management of perforated appendicitis. Routine IA is not necessarily indicated for these children. 相似文献17.
Background
The purpose of this study was to evaluate the possibility of expanding the selection criteria in living donor liver transplantation (LDLT) to treat hepatocellular carcinoma (HCC).Methods
From October 2000 to December 2010, we retrospectively analyzed 71 patients who had undergone LDLT beyond the Milan criteria (MC), among the entire cohort of 199 HCC patients. We evaluated the tumor biology as well as overall and disease-free survival (DFS), seeking to identify risk factors for recurrence. The median follow-up was 37 months (range 5-124).Results
Among the 71 patients beyond the MC were 18 recurrences and 30 deaths. Their 5-year overall and DFS rates were 52.3% and 67.7%, respectively. On multivariate analysis, tumor diameter, tumor number, and E-S grade significantly influenced overall and DFS. According to our new criteria (size ≤7 cm, number ≤7), 86% of our patients would be included compared with 64% using MC. Five-year DFS and overall survival rates according to our criteria were comparable with the MC: 86.8% and 72.3% versus 86.8% and 73.4%, respectively.Conclusion
Our criteria appear to achieve useful cut-off values beyond the MC. 相似文献18.
Gregory J. Landry Jessica R. Carlson M.S. Timothy K. Liem M.D. Erica L. Mitchell M.D. James M. Edwards M.D. Gregory L. Moneta M.D. 《American journal of surgery》2009,197(5):655-659
Introduction
Femoral wound complications can threaten vascular grafts. Muscle flaps can be used to facilitate soft-tissue coverage and graft salvage. We report a series of sartorius flaps performed by vascular surgeons in the treatment of complicated femoral wounds.Methods
Rotational sartorius flaps were performed to attempt salvage of underlying vascular grafts. We reviewed a prospective database to determine the outcomes of sartorius flaps on facilitating wound healing and graft salvage and patency.Results
From 2005 to 2008, 21 sartorius flaps were performed in infected or threatened femoral wounds. Original operations included femoral endarterectomy with patch repair in 8, aortofemoral graft in 6, axillofemoral graft in 4, and femoral-distal bypass in 3 patients. Complete wound healing occurred in 18 patients (86%). Primary wound closure was achieved in 7 patients. Secondary wound closure was achieved in 11 patients with mean healing time of 2.3 months. All vascular reconstructions remained patent at the 9.5-month follow-up.Conclusions
Sartorius muscle flaps are effective at facilitating complicated femoral wound healing while maintaining graft salvage and patency. 相似文献19.
K Morita T Seki D Iwami H Sasaki N Fukuzawa K Nonomura 《Transplantation proceedings》2012,44(6):1795-1799
Background
Spontaneous rupture risk of a renal artery aneurysm (RAA) is extremely low. Indications for surgical repair of RAA remain uncertain.Objective
Long-term outcomes of conservative therapy and surgical repair were evaluated.Patients
The study included 58 patients (17 males, 41 females) who were diagnosed with RAA during the last 21 years. Median age at the time of diagnosis was 62 (19-85) years, and the median follow-up 69 months (range 3-216).Methods
The patients were divided into two groups, conservative group (n = 30) who had been followed with blood pressure control, and treatment group (n = 29), who underwent an intervention.Results
Multiple efferent aneurysmal branches were observed in seven conservative and 16 treatment cases (P = .002). The median maximum diameter of the aneurysm was lower in the conservative than the treatment group (15 versus 25 mm, P = .005). Two conservative group cases showed increases in aneurysm size during follow-up. The hypertensive state showed essentially no change in either group during the follow-up. Renal function decreased with age similarly both in conservative and treatment groups.Conclusions
Our conservative management criteria for RAA are justifiable and even too strict. 相似文献20.
Juan Manuel Suárez-Grau Salvador Morales-Conde Carolina Rubio Chaves Francisco Palma Ramírez Salvador Morales Méndez 《Cirugía espa?ola》2009,86(4):242-248