Bronchial Adenoma: A Review of 26 Cases

A retrospective review of 26 cases of bronchial adenoma is presented, with an analysis of symptoms, X-ray and bronchoscopic findings, surgical management, pathology aid postoperative course. Twenty-two patients are known to be alive and well, with no clinical or radiological evidence of recurrence at review six months to 18 years after operation. This review supports the previously recognized opinion that resection by thoracotomy is the treatment of choice and that this resection should be as conservative as possible. The long-term results of even the most conservative operative procedures are satisfactory.     

Percutaneous nephrostomy and irrigation lithochemolysis a new concept for the treatment of cystine stones

A case is reported of the dissolution of a cystine stone in the left renal pelvis by means of irrigation with N-acetyl-cysteine via percutaneous nephrostomy. As a result of this treatment no further operative measures were necessary. In our opinion the surgical removal of cystine stones is probably no longer necessary.     

Surgical treatment of coexistent aortic, peripheral vascular and coronary disease

To determine the priority of the surgical treatment of coexistent aortic and coronary disease (CAD), we reviewed 19 cases of aortic aneurysm combined with severe coronary lesions who underwent operation from Jan, 1984 to Aug, 1989. There were 15 cases of abdominal and 4 cases of thoracic aneurysm. All patients had graft replacement for the aneurysm and 12 patients had elective aortocoronary bypass surgery (CABG), one had percutaneous transluminal coronary angioplasty and 6 received medical treatment for CAD. In 6 cases, CABG preceded abdominal aneurysm operation. In 3 cases of ascending thoracic aneurysm, simultaneous coronary and aortic operation were performed. There were no early and late operative death. In an attempt to reduce perioperative myocardial infarction which is one of the most frequent complications of aneurysmal operation, we performed routine coronary angiogram before operation. In 104 patients considered for elective aortic and peripheral vascular disease, coronary angiogram were performed. The incidence of coexistent coronary artery disease in peripheral vascular and aortic disease were 46.1%. The incidence of multiple vessel CAD in patients with aortic and peripheral disease were high. Our surgical strategy for coexistent aortic, peripheral vascular and coronary disease is basically staged operation and simultaneous operation are performed only in ascending and proximal arch aneurysm.     

Occlusion of the right pulmonary artery due to acute dissecting aortic aneurysm

A 58-year-old female was admitted with an abrupt onset of chest and back pain. The CT scan of the chest showed aortic dissection of the ascending aorta and proximal aortic arch, but the false lumen of the aortic dissection had already been occluded by a blood clot. After admission, she complained of chest pain with hemoptysis and presented facial edema and the distention of the neck veins. The pulmonary angiogram showed complete occlusion of the right pulmonary artery at the proximal segment. These findings were interpreted as pulmonary embolism. She was treated with intravenous heparin and urokinase, but these treatments did not demonstrate any improvement. She underwent a surgical exploration on the fourth hospital day. During surgery, the right pulmonary artery was discovered to be compressed and occluded by the large dissecting aneurysm of the ascending aorta. In addition, hematoma was seen between the right pulmonary artery. The ascending aorta and pulmonary trunk, which was injured in the operative procedure, were replaced with an artificial graft successfully. Postoperative pulmonary angiogram showed no stenosis of right pulmonary artery. The occlusion of the pulmonary artery by an acute dissecting aneurysm is an extremely rare complication and it is often wrongly diagnosed as pulmonary embolism. In such cases, the correct diagnosis and prompt surgical treatment is essential and antithrombolytic and anticoagulant therapy should be avoided.     

The radiological diagnosis of hepatoma with special emphasis on angiography.

The radiological findings of 69 out of a total of 81 cases of proven primary hepatocellular carcinoma are reviewed retrospectively. Selective angiography was performed on 42 patients and the results are analysed according to specific angiographic findings and distribution of the neoplasm, Because of the more aggressive approach to surgical treatment of hepatomas, angiography is of utmost importance in the pre-operative evaluation of the extent of the lesion and the vascular supply to the liver. Apart from the conventional angiogram, the technique of slow-infusion hepatic angiography is discussed as well as the value of enhancement techniques such as photographic subtraction and the use of vasoconstrictor drugs. Response to chemotherapy can be assessed by an infusion hepatic angiogram if a catheter has been surgically placed in the hepatic artery. The majority of tumours were easily disgnosed on the angiogram but special problems were encountered in distinguishing multicentric forms of hepatoma from hepatic metastases and avascular lesions from primary cholangiocarcinoma. The wide variety of clinical and angiographic findings that may be found, are emphasised in 4 brief case repots.     

Laparoscopic treatment of the ovarian cysts

Laparoscopy is widely used as a safety procedure in many clinical situations allowing diagnosis and/or surgical management in a minimally invasive fashion. Most laparoscopic cases allow patients to recover quickly. The conventional ultrasonography and endovaginal sonogram appear to be useful in the pre-operative selection for this surgery. Conventional pulsed Doppler (Duplex) and color Doppler sonography (CDS) have added a new dimension to pelvic ultrasonography. This study was undertaken to evaluate usefulness of operative laparoscopy in treatment of ovarian cysts. A retrospective study was carried on 35 operative laparoscopy cases performed between 1995 and 2000. Types of surgery performed were cystectomy, salpingo-oophorectomy, oophorectomy and wedge resection. The mean operation time was in the range of 65 to 120 minutes, mean while the mean postoperative stay was of 3,8 days.     

32例感染性心内膜炎治疗的临床分析

目的探讨左心IE与右心IE两者临床表现及治疗上的差异。方法对中山大学第二附属医院2000年1月～2004年12月住院的32例IE病人分成左心IE组、右心IE组进行回顾性对照分析。结果左心IE中内科治疗15例,其中治愈4例;外科治疗10例并全部治愈,其中行瓣膜置换术9例,瓣膜修复整形术1例;右心IE中内科治疗2例,其中治愈1例;外科治疗5例,其中行三尖瓣置换术4例,三尖瓣膜修复整形术1例;手术治疗5例中治愈4例,1例因术后多器官功能障碍综合症死亡。结论右心IE与左心IE临床表现不同,突出表现在肺部病变:右心IE表现为急性肺炎或肺栓塞的临床症状;左心IE表现为瓣膜功能障碍。对于IE瓣膜病变的手术方式应根据瓣膜损坏程度来决定,左心IE以瓣膜置换为主,右心IE尽量争取瓣膜修复整形。     

Recent changes in the assessment of urogenital tuberculosis

The urogenital tuberculosis has undergone a change in form and clinical assessment. The absolute proportion of urogenital tuberculosis cases has fallen off sharply since 1967. The number of surgical interventions is also remarkably reduced. The cases exhibiting a milder stage have significantly increased, while the severe cases have decreased. This change of tuberculosis has made a conservative therapy favorable; therefore the current operative indication is somewhat different than 15 years ago. The time of release from the stationary treatment depends first on the animal experiment and bacterial findings; furthermore, tests are necessary to determine the status of immunity. It was revealed with urogenital tuberculosis, through regular examination of the menstrual blood of women, that the number of positive cases among women was considerably higher, than among men. In contracted bladder a surgical intervention is often necessary due to intense pain and incontinence. We prefer the rectal bladder with sigmoid pull-through inside the sphincter ani, whereby excellent success can be achieved. The study shows that the clinical assessment of tuberculosis is somewhat different today than is was earlier. Tuberculosis underwent a change in form that must be taken into consideration with respect to operative indication.     

The UCLA surgical approach to sphincteric incontinence in women

Stress urinary incontinence (SUI) in the female may be treated by a variety of non-surgical and surgical therapies. However, once the patient has chosen to undergo operative repair the ideal procedure is based on three considerations: the degree of anterior vaginal wall prolapse, the degree of incontinence and associated anatomic abnormalities requiring surgical repair. In the vast majority of cases vaginal wall sling is our procedure of choice for the surgical treatment of SUI in the female. Vaginal wall sling is based on sound anatomic principles, may be performed as an outpatient procedure and is equally efficacious for the treatment of SUI due to anatomic incontinence (urethral hypermobility) and intrinsic sphincter deficiency. Since vaginal wall sling is performed through a transvaginal approach, other associated manifestations of pelvic floor prolapse such as rectocele can be addressed and repaired simultaneously. When necessary the vaginal wall sling can be easily modified to repair large grade cystoceles.     

The treatment of fecal incontinence

The treatment of faecal incontinence includes: the education of the patient, medical therapy, biofeedback and sphincteric exercises, surgical therapy. Conservative, non-surgical treatment is almost always the initial therapeutic approach, except in those cases in which an evident defect of the sphincter muscle is present. Surgical treatment has seen a noteworthy increase in the last fifteen years as a consequence of the development of new surgical techniques. These techniques include: external anal sphincter plasty, pelvic floor plasties, sacral neuromodulation, muscular transpositions with or without electrostimulation, artificial anal sphincter. These procedures may be employed as first or second level treatment depending on the type of pathology considered and its aetiology. The 1st results achieved by surgical treatment authorise us to believe that reconversion with artificial sphincter is a valid alternative to graciloplasty, notwithstanding the fact that its costs are higher. Attentive pre- operative assessment of patients is important. Patients must be strongly motivated and able to manage the new condition. Although further studies are necessary, the degree of satisfactory of the 1st patients operated is the best stimulus for pursuing the development of this technique.     

闭合性胰腺损伤的诊治（附17例报告）

目的　分析闭合性胰腺损伤的诊断与治疗方法。方法　对 17例闭合性胰腺损伤患者的诊断、手术方式、手术效果及并发症的处理进行总结分析。结果　 17例中 ,发生并发症 4例 ,死亡 1例。结论　胰腺损伤术前很难做出诊断。诊断的关键是剖腹探查 ;胰腺损伤的手术方式较多 ,应根据胰腺损伤的具体情况选择合理的手术方式 ,才能减少并发症和死亡率的发生     

Hormonal and surgical bases for treatment of undescended testis

The status of the hormonal and surgical methods of treatment for the undescended testis depends upon our present knowledge of the action of the gonadotropic factor and the limits of effectual surgery. Each method is well adapted to about 50 per cent of cases. Hormonal therapy will prevent a number of operative procedures. On the contrary, surgical treatment is necessary for a certain group. Another group of cases is best treated by a combination of the hormonal and surgical methods. Those patients whose testes are situated high will respond better to surgical treatment if they are given preoperative treatment with the gonadotropic hormone. Other cases which would be partial or complete surgical failures are made successful by the postoperative administration of the gonadotropic factor which relieves the tension on the cord and prevents retraction of the testis.     

Treatment for traumatic aneurysm of the cerebral artery--identification between deteriorating type and spontaneously disappearing type (author's transl)]

Thirty five cases of traumatic aneurysm of the cortical cerebral artery were reviewed in the literatures cited in the references. Five cases of them healed spontaneously without operative treatment (disappearing type), the other cases underwent direct operation of aneurysm, in spite of high operative moltality or mobility (deteriorating type). Recently four cases of traumatic aneurysm of the cortical cerebral artery were treated in our clinic. Three cases which had the aneurysm in the pericallosal artery (1 case) and middle cerebral artery (2 cases) respectively underwent radical operation for treatment as progressively deteriorating type and fourth case which had the aneurysm in the peripheral part of the frontopolar artery was treated by medication as the spontaneously disappearing type until the aneurysm disappeared on the angiogram. According to the review of literatures, it is the most important for the treatment of tramatic aneurysm to know whether disappearing type or deteriorating type, because deteriorating type had bad prognosis without radical operation and the prognosis of disappearing type was excellent without operation. Analysing the clinical signs and angiographical findings of the all cases, the authors found out some specific characteristics of the spontaneously disappearing type. are (1) The aneurysm is found in the relativery late post traumatic stage except for cases caused by penetrating wound, (2) The irregular shape, uneven opacity of the aneurysm without clear neck connecting with pearent artery on angiography, (3) Shape and size of the aneurysm in follow up angiogram (two weeks or more) became smaller, (4) Around of aneurysm, there are not any kind of intracranical hemetoma. According to these results, differential diagnosis between spontaneously disappearing type and deteriorating type was done in the author's four cases and the three cases of deteriorating type were relieved by radical operation without any postoperative disability and one case of spontaneously disappearing type was treated by medical treatment until disappear of aneurysm. It is concluded that traumatic aneurysm of the cortical cerebral artery is relative rare and it is important to know whether deteriorating type or spontaneously disappearing type in order to get excellent results.     

四步正踝法治疗Ⅱ度以上旋后外旋型踝关节骨折的病例对照研究

目的:探讨四步正踝手法复位治疗Ⅱ度以上旋后外旋型踝关节骨折的疗效,分析其复位机制。方法:自2005年至2008年治疗95例新鲜Ⅱ度以上旋后外旋型踝关节骨折,分手法组和手术组。其中手法组43例,男11例,女32例;平均年龄(44.95±12.65)岁;骨折分度:Ⅱ度2例,Ⅲ度11例,Ⅳ度30例。手术组52例,男21例,女31例;平均年龄(39.96±13.28)岁;骨折分度:Ⅱ度6例,Ⅲ度18例,Ⅳ度28例。手法组采用四步正踝法闭合复位、硬纸夹板外固定;手术组采用切开复位内固定治疗。骨折治疗前后、治疗后2个月时通过X线片检查评估骨折对位情况;骨折治疗后6个月后通过Olerud-Molander评分系统评价疗效及踝关节功能恢复情况。结果:95例均获随访,所有患者骨折愈合,手术组3例出现伤口并发症,手法组无不良反应。术后6个月手法组,优19例,良20例,可4例;手术组,优30例,良20例,可2例。2组在骨折对位情况、踝关节功能恢复情况等方面差异无统计学意义(P>0.05),Ⅳ度骨折手术治疗疗效优于手法治疗(P<0.05)。结论:四步正踝法治疗旋后外旋型踝关节骨折简便安全、疗效可靠,Ⅳ度骨折建议早期闭合复位,必要时手术治疗。     

精索扭转的诊断和治疗(附14例报告)

目的：探讨精索扭转的诊断和治疗方法。方法：结合文献复习，回顾性总结14例精索扭转的临床资料。结果：8例术前彩色多普勒超声检查（CDS）诊断并经手术证实，符合率100％。经手术探查，4例行手术复位，固定，睾丸获救，10例行患侧睾丸切除术，所有病例均行对侧探查，固定。结论：CDS是诊断急性精索扭转的首选方法，治疗上应尽快手术探查，复位并做预防性固定。     

重症急性胰腺炎外科手术的评估

目的：总结近８年来重症胰腺炎的治疗经验。方法：分非手术和手术二组、二组病人均在ＩＣＵ监护和治疗，分析二组病人治疗后的疗效。结果：手术组３３例，死亡１１例（３２．４％），术后出现各种并发症和器官功能衰竭１５例（４４％），平均住院天数８７天。非手术组２０例，死亡２例（１０％），并发症９例（４５％），平均住院３４天。结论：对ＳＡＰ采用早期外科手术的观点应当改变。外科手术在ＳＡＰ中的指片应是梗阻性胆源性胰     

Acoustic neurinomas associated with vascular compression syndromes

Summary Trigeminal neuralgia and hemifacial spasm are caused by vascular compression of the cranial nerves at the brainstem in the majority of cases. Trigeminal neuralgia occurring in 3.3% of acoustic neurinomas is usually assumed to be a sign of large tumour size; if associated with small tumour size, an additional pathology, such as typical vascular compression must be suspected and has to be explored at surgery. While facial paresis will usually lead to immediate radiological diagnosis of a possible cerebellopontine angle (CPA) neoplasm, facial spasm is usually not expected to be associated with a CPA tumour. We report on clinical presentation, operative findings, surgical treatment and results in 9 cases of small acoustic neurinomas associated with trigeminal neuralgia and on 4 cases associated with hemifacial spasm. The importance of the clinical characteristics is stressed; if these are typical of a vascular compression syndrome, further exploration at the time of tumour surgery and specific treatment by vascular decompression are necessary.     

Neuroendoscopy: one year of experience--personal results, observations and limits.

After reading reports of successful neuroendoscopic treatment of hydrocephalus, colloid cysts and arachnoid cysts as well as tumor biopsy, we started using endoscopic procedures in our Department, one year ago. One surgeon (E.S.) skilled in the Decq Endoscope, performed a series of sixteen procedures, from January 2001 to March 2002 (in patients aged 28 to 69 years). The most common pathology was obstructive hydrocephalus (14 cases), one was colloid cyst, and the last case was tumor biopsy. The surgical treatment consisted of third ventriculostomy, cyst opening and shrinking and tumor biopsy. In fourteen patients treated for hydrocephalus with third ventriculostomy (ETV), one required a definitive shunt. Complication occurred in one case with chronic subdural collection. We further report one case of aqueductal restoration after third ventriculostomy. Our results, with no neurological deficits or deaths, confirmed our opinion that neuroendoscopy is a safe surgical technique in well-selected patients and we believe it is the ideal treatment in obstructive hydrocephalus.     

Preoperative assessment of microvascular decompression for hemifacial spasm with fusion imaging of 3D MR cisternogram/angiogram

The preoperative assessment of microvascular decompression (MVD) for hemifacial spasm has been performed with MRI, but assessment of the compressive status by 2D imaging has a number of limitations. We used a fusion image of the 3D MR cisternogram and co-registered 3D MR angiogram, reconstructed from MR cisternogram, obtained by 3D fast spin-echo sequence, and MR angiography, 3D time-of-flight and spoiled-gradient recalled sequences, for the preoperative assessment of the offending artery in 10 patients with hemifacial spasm. The anatomical relationship of the nerve-vessel complex was assessed on the simulated images, and compared with the intraoperative findings. The fusion image of the 3D MR cisternogram/angiogram depicted contours of the brain, nerves, and vessels clearly, and that allowed precise assessment of the pathogenic compression of the facial nerve by the offending vessels, comparative to the operative findings. The fusion imaging of the 3D MR cisternogram/angiogram may provide useful information in the surgical planning of MVD for hemifacial spasm.     

Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements

Second opinion in pathology is intended to expose clinically significant errors that have a direct impact on patient care. Before definitive treatment of referred patients, our institution requires a second opinion of outside surgical pathology slides. We sought to determine if this local standard of practice has a measurable impact on patient care via clinical and pathologic follow-up. 5629 second opinion surgical pathology cases seen at the University of Iowa Hospitals and Clinics were studied. Each case was classified as: no diagnostic disagreement, minor diagnostic disagreement, or major diagnostic disagreement by the second opinion pathologist at the time of referral. A major diagnostic disagreement was defined as a change in pathologic diagnosis with potential for significant change in treatment or prognosis. Major diagnostic disagreements were categorized by organ system and according to the clinical significance of the changed diagnosis based on clinical and pathologic follow-up. Second opinion surgical pathology resulted in 132 (2.3% of total cases) major diagnostic disagreements and 507 (9.0%) cases with minor disagreements. The organ systems involved in the majority of the major disagreements were the female reproductive tract (32), gastrointestinal tract (27), and skin (24). Of the 132 major diagnostic disagreements, 68 (1.2% of total cases reviewed) prompted changes in the clinical management as a result of the second opinion interpretation. These findings support the idea that mandatory second opinion is an important part of patient care in the referral setting.