Endoscopic surgery of pituitary tumors

Endoscopic pituitary surgery has been gaining wide acceptance as the first-line treatment of most functional pituitary adenomas. This technique has many advantages over traditional procedures, and growing evidence supports its use for endocrine control of functioning tumors. This article reviews data on the different modalities of treatment of functioning pituitary adenomas and compares the results. Endoscopic pituitary surgery controls tumor growth and endocrinopathy as well as or better than other treatment modalities. Complication rates are low and patient recovery is fast. Furthermore, surgery provides a means of achieving prompt decompression of neurologic structures and endocrine remission.     

Gossypiboma: an unusual intracranial complication of endoscopic sinus surgery

We report a case of a 52-year-old man who presented with iatrogenic bilateral nasoethmoidal meningoencephaloceles following endoscopic nasal surgery performed in a neighboring country 8 years ago. Imaging studies, including computed tomography and magnetic resonance imaging of the paranasal sinuses and anterior skull base, demonstrated bilateral meningoencephaloceles and a suspicious intracranial lesion. In view of the intracranial lesion and size of the skull base defect, an external approach via a bicoronal flap was used for exploration and repair. Intraoperative findings revealed the suspicious intracranial lesion to be a retained piece of gauze. The patient underwent a successful removal of the foreign body and repair of the skull base defect. Postoperative recovery was uneventful. To our knowledge, an iatrogenic intracranial foreign body following an endonasal endoscopic procedure has never been reported before.     

An evaluation of two Rapid Access Chest Pain Clinics in central Lancashire, UK

AIM: The aim of the project was to assess critically, using Maxwell's six dimensions, the quality of the services provided by the two Rapid Access Chest Pain Clinics (RACPCs) in Central Lancashire. METHODS: Data on the actual use of the clinic was obtained from the two RACPCs. A record linkage exercise between the database of patients from the RACPC and HES/mortality data was performed. Expected use of the clinic was established from the performance of other RACPCs and from published angina incidence figures. Patient and general practitioner views were obtained by conducting questionnaire surveys. KEY RECOMMENDATIONS: (1) Clinic is providing a valuable service and should be continued. (2) A standardized database should be created which includes ethnicity and final diagnosis. (3) Alternative methods for rapid diagnosis and management of chest pain need to be provided for patients who are not suitable for the exercise electrocardiogram. (4) Referral criteria should be redrafted in order to remove the exclusion criteria for patients with chest pain of longer duration than 3 months. (5) Further resources need to be targeted at cardiology outpatients and revascularizations, as waiting times for patients with a positive test are felt to be too long.     

A Comparative Study of Laparoscopic with Conventional Open Donor Nephrectomy in Renal Transplantation

Background

Laparoscopic donor nephrectomy (LDN) has been gaining popularity among kidney donors. There have been concerns about the safety and efficacy of the procedure as compared to open donor nephrectomy (ODN). We compare our results on LDN with ODN.

Methods

We retrospectively analysed our data of LDN and ODN. Duration of surgery, blood loss, period of hospitalisation, per oral intake and analgesic requirements.

Result

22 LDNs were done, the operation time ranged from 220-300 minutes, and blood loss from 100-150ml. In the first 10 laparoscopic operations four cases required conversion to open surgical dissection. Only one case was converted to open surgery in the subsequent 12 laparoscopic cases. Oral intake was started on the first postoperative day. Analgesic requirement in laparoscopy cases was less. Patients were mobilised on the first day after surgery. Patients were discharged by seventh day. There was no significant difference in the functioning of the graft after revascularisation in the recipient.

Conclusion

Laparoscopic donor nephrectomy is a safe and effective technique of donor nephrectomy.Key Words: Laparoscopy, Laparoscopic donor nephrectomy, Living kidney donors, Kidney transplantation