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991.
Mathieu MC Bonhomme-Faivre L Rouzier R Seiller M Barreau-Pouhaer L Travagli JP 《Annals of surgical oncology》2007,14(8):2233-2238
Background In breast carcinomas treated with neoadjuvant chemotherapy, intraoperative identification of residual tumors may be difficult.
A well-tolerated, low-diffusion charcoal suspension has been designed to tattoo breast tumors. In this study, we investigated
whether this tattooing technique is efficient for localizing the tumor after treatment with chemotherapy.
Methods In a series of 109 patients with large breast tumors, a 4% or 10% charcoal suspension was injected at the time of the initial
biopsy before preoperative chemotherapy.
Results Tolerance was good. After three or four cycles of chemotherapy, 91 patients underwent conservative treatment, and the surgical
specimen was examined intraoperatively. The charcoal was detected in 94% of the cases. The charcoal was seen in the nodule
or at the periphery in the surgical specimen without any acute inflammatory reaction or diffusion.
Conclusions On the basis of these results, this micronized charcoal suspension at a defined granulometry and a concentration of 10% seems
to be ideal for tattooing breast carcinomas over a period of 3 months in patients in whom neoadjuvant chemotherapy is planned. 相似文献
992.
Hirano Y Ishikawa N Omura K Inaki N Hiranuma C Waseda R Watanabe G 《Surgical endoscopy》2007,21(11):2112-2114
Background
Intragastric surgery is accepted as a minimally invasive procedure for mucosal or submucosal lesions. Robotic surgery promises to extend the capabilities of the minimally invasive surgeon and many surgical specialties are applying this new technology. However, there is no report of robotic intragastric surgery. We describe the use of the da Vinci® Surgical System for intraluminal mucosal resection of the stomach.Methods
We developed our porcine intragastric surgery model using the Tuebingen MIS Trainer. We set a tentative lesion on the posterior wall near the esophagocardiac junction (ECJ) of the stomach and performed mucosal resection of the lesion using the da Vinci Surgical System. We also performed closure of the defect after mucosal resection and subsequent closure of the intentional gastric perforation.Results
Using our porcine intragastric surgery model, we successfully performed mucosal resection of the tentative lesion. We also smoothly completed closure of the defect and closure of the perforation without any complications. The mean size of the mucosa was 6 cm and the mean duration of the procedure was only 12 min.Conclusions
The safety and efficacy of robotic intragastric surgery was preliminarily established in this study. However, further studies are needed to prove its practical feasibility in humans using the da Vinci Surgical System to make it an effective operation.993.
Pradeep PV Agarwal A Baxi M Agarwal G Gupta SK Mishra SK 《World journal of surgery》2007,31(2):306-312
Background Ideal management of toxic goiter still remains elusive. Though surgical management of toxic multinodular goiter (MNG) is well
accepted, surgical treatment of Graves’ disease (GD) is still controversial in view of the presumed increased incidence of
complications. In this paper, we discuss the experience of the surgical management of hyperthyroidism at a specialized tertiary
care endocrine center in a developing country, highlighting the minimal morbidity and satisfactory outcome in experienced
hands.
Materials and methods We retrospectively reviewed 325 consecutive patients with hyperthyroidism managed surgically from 1990 to 2005. The etiologic
diagnoses were Graves’ disease (185), toxic MNG (105), and autonomously functioning thyroid nodules (AFTN) (n = 35). The indications
for surgery in Graves’ patients were large goiter, relapse after antithyroid drug therapy (ATD), Graves’ ophthalmopathy, and
presence of nodule. The indications for surgery in toxic MNG were retrosternal extension (n = 15), compressive symptoms (n = 20),
and large size (grade II). Among the AFTN nodule size, those greater than 4 cm (85%) formed the major indication for surgery.
Subjects with GD and toxic MNG were subjected to subtotal thyroidectomy (n = 93 prior to 1995) or total thyroidectomy (n = 205
post-1995). Hemithyroidectomy was the procedure of choice in patients with AFTN.
Results Patients with Graves’ disease were younger in age, with shorter mean duration of goiter when compared with the other 2 groups.
Eight percent of patients with Graves’ disease without a clinically palpable nodule and 25% of those with nodules had associated
differentiated carcinoma, including papillary, follicular, and medullary thyroid cancer. Four percent of patients with toxic
MNG had malignancy. Complications included temporary hypocalcemia (24%), permanent hypocalcemia (3%), and permanent vocal-cord
palsy (1%).
Conclusions Surgery for hyperthyroidism has negligible mortality and acceptable morbidity in experienced hands. It is a definite option
in selected cases. Immediate and permanent cure of hyperthyroidism is achieved, with no recurrences, after total thyroidectomy.
The cosmetic outcome is good, with excellent patient satisfaction and acceptance. 相似文献
994.
Gastroesophageal reflux disease (GERD) is a common disease and can be successfully treated by laparoscopic fundoplication.
This article describes the technique of laparoscopic surgery for GERD with a focus on operative pitfalls. 相似文献
995.
Trombetta C Liguori G Bucci S Benvenuto S Garaffa G Belgrano E 《World journal of urology》2007,25(4):381-384
To report and discuss four cases of renal cell carcinoma (RCC) in which preoperative investigations yielded contradictory
results regarding the cranial extension of propagation of the tumor thrombus into the vena cava. An intraoperative ultrasound
scan (IOU) was performed in all cases to identify the exact level of the tumor thrombus. We have performed an IOU of the vena
cava in four patients with RCC propagation into the inferior vena cava. Preoperative investigations were performed in all
patients and consisted of abdominal Ultrasound scan (USS), contrast enhanced CT scan and gadolinium enhanced MRI scan. Intraoperative
ultrasound has identified correctly the cranial extension and the absence of tumor thrombus infiltration in all patients.
The thrombus reached the suprahepatic vena cava in two cases and was confined to the infrahepatic vena cava in the remainder.
Preoperative imaging investigation had failed to determine the correct cranial extension of the tumor thrombus in two patients.IOU
is a very useful tool to accurately assess the precise extent of tumor thrombus and eventually the presence of vein wall infiltration.
These data are of paramount importance to plan the optimal surgical approach. According to our experience this type of investigation
identifies the cranial extent of a tumor thrombus inside the vena cava better than standard imaging techniques. 相似文献
996.
Nakajima J Morota T Matsumoto J Takazawa Y Murakawa T Fukami T Yamamoto T Takamoto S 《Surgery today》2007,37(6):496-499
Intimal sarcoma of the pulmonary artery is a rare disease. This neoplasm was characterized by an aggressive extension to the
lumen of the pulmonary artery, thus mimicking a pulmonary thromboembolism. We herein report a 44-year-old woman who was diagnosed
as having primary intimal sarcoma of the left lung preoperatively by transbronchial biopsy. The tumor originated in the pulmonary
artery in the left lung, extending to the main pulmonary trunk via the pulmonary arterial lumen, thus resulting in stenosis
of the main pulmonary trunk. A complete resection of the tumor with the left pneumonectomy and the pulmonary arterioplasty
was successfully performed under cardiopulmonary bypass with vacuum assisted venous drainage. 相似文献
997.
Although locoregional recurrence is often observed in the cervicothoracic area even after an esophagectomy with three-field
lymph node dissection (3FL), recurrence in the mediastinal lymph nodes is relatively rare. We experienced two cases of solitary
recurrence in a posterior mediastinal node (No 112-ao) after a curative resection for thoracic esophageal cancer. The lymph
node recurrence was located in the connective tissue adjacent to the left posterior wall of the thoracic aorta, and thus could
not have been removed by the conventional approach of an esophagectomy through a right thoracotomy. These two patients underwent
surgical removal of the tumor through left thoracotomy, and survived for 5 years and 1 year without recurrence, respectively.
Because the rate of metastasis in this area appears to be low, it is not always necessary to perform complete nodal dissection
of the left side of the descending aorta at the initial surgery in cases of thoracic esophageal cancer. However, our experience
suggests the importance of periodic computed tomography scans to check for any nodal recurrence in this area, since a surgical
resection may be effective when the recurrence is detected as a solitary metastasis. 相似文献
998.
Background Patients with advanced pancreatic neuroendocrine tumor, even in the presence of unresectable hepatic metastases, have survival
usually measured in years than in months. Theoretically, we would have reason to resect symptomatic primary pancreatic neuroendocrine
tumors from these patients palliatively. However, the effect and feasibility of removing symptomatic primary pancreatic neuroendocrine
tumor in patients with unresectable hepatic metastases has never been addressed.
Methods In 2000, we instituted a prospective study to resect symptomatic primary tumors and treat unresectable hepatic metastases
by lanreotide and hepatic artery embolization in patients with definite tissue proof of pancreatic neuroendocrine tumor.
Results Thirteen patients were included in this study; seven patients underwent pancreaticoduodenectomy, and six underwent distal
pancreatectomy and splenectomy. There were no operative deaths. Eight of thirteen patients had no radiologic evidence of disease
progression. The other five patients had disease progression by their 6-month follow-up; they underwent hepatic artery chemoembolization
or chemotherapy. One patient died of multiple lung and bone metastases 80 months after operation, and one patient died of
continuous progression of liver metastases 18 months after operation. Telephone interviews of 11 patients who survived revealed
that 10 reported improved quality of life after resection of symptomatic primary pancreatic neuroendocrine tumor and one patient
reported no change.
Conclusions We suggest that symptomatic primary pancreatic neuroendocrine tumors should be resected even when unresectable hepatic metastases
are found at diagnosis because of the relatively low risk of pancreatic surgery, effective elimination of symptoms caused
by primary tumors, and slow progression of hepatic metastases under lanreotide and hepatic artery embolization. 相似文献
999.
Udo Lorenz Marianne Abele-Horn Dieter Bussen Arnulf Thiede 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):761-765
Background To our best knowledge, Panton–Valentine leucocidin (PVL)-positive methicillin-sensitive Staphylococcus aureus (MSSA) has not been described yet as cause for severe pyomyositis.
Case report We present a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis
secondary to an operated pilonidal cyst. In the follow-up, the patient showed signs of immunocompromisation. The causative
agent for purulent infection of multiple muscles was a MSSA strain harbouring PVL toxin.
Results In the reported case, aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead
to recovery from the disease without relapse.
Conclusions PVL-positive S. aureus are associated with skin diseases, multiple abscesses and often complicated by severe sepsis and necrotising pneumonia. Under
such circumstances, the mortality rate can reach up to 75%. In addition, the PVL toxin can cause immunocompromisation and
might be therefore involved in the aetiology of pyomyositis. Aggressive antibiotic and surgical treatment with additional
application of immunoglobulins is recommended for treatment. 相似文献
1000.
Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual delayed presentation of renal
arteriovenous fistula following blunt trauma.
A gentleman presented with hematuria and clot colic. Following initial investigations, renal arteriography showed an arteriovenous
fistula in the mid-pole of the right kidney. The fistula was successfully occluded by super-selective coil embolization.
Although this case is an unusual presentation, AV fistulae must be ruled out in management of patients of hematuria. 相似文献