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61.
Pasquale Farsetti Matteo Benedetti-Valentini Vito Potenza Ernesto Ippolito 《Journal of children's orthopaedics》2012,6(6):463-469
Purpose
“Hinge abduction” is a complication of Perthes’ disease caused by impingement of the extruded superolateral portion of the femoral head against the lateral lip of the acetabulum. Catterall first described femoral valgus extension osteotomy (VGEO) to treat this condition. We report the results of this operation in 16 cases of Perthes’ disease with “hinge abduction”.Methods
Sixteen hips in 16 patients affected by Perthes’ disease and “hinge abduction” were operated on at a mean age of 10.1 years and followed up an average of 6.5 years later. Before surgery, the mean Iowa hip score was 44.4 points. Preoperative radiographs were taken with the affected hip in maximum adduction in order to calculate the amount of valgus correction. The osteotomy was performed between the greater and the lesser trochanter, and it was fixed with a hip plate.Results
All the osteotomies healed uneventfully. At follow-up, no patient complained of pain and hip abduction ranged from 20° to 45°. Four out of the 16 patients had a moderate limp, and 12 had an improvement in gait pattern compared to preoperatively. At follow-up, the Iowa hip score totaled a mean of 83.6 points, with a statistically significant improvement in comparison to the preoperative evaluation. At follow-up, two hips were classified as Stulberg II–III, ten hips as Stulberg III, and four as Stulberg IV.Conclusions
In our hands, VGEO was an effective procedure to treat “hinge abduction” in severe Perthes’ disease with satisfactory results. The main limitation of our study is its short follow-up. 相似文献62.
La Torre M Nigri G Ferrari L Cosenza G Ravaioli M Ramacciato G 《The American surgeon》2012,78(2):225-229
An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers (P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year, respectively (P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals dedicated to pancreatic surgery. 相似文献
63.
64.
Rodolfo Milani Matteo Frigerio Federico Spelzini Stefano Manodoro 《International urogynecology journal》2017,28(5):789-791
Introduction and hypothesis
Uterine-sparing procedures could be attractive in patients concerned about fertility preservation and corporeal image changes. Transvaginal uterosacral ligaments (USLs) hysteropexy can provide a mesh-free technique for uterine suspension. This video is intended to serve as a tutorial for surgical steps.Methods
A 38-year-old woman with symptomatic stage III POP desired preserving fertility. After proper counseling, the patient was admitted for vaginal hysteropexy through bilateral high USL suspension according to the featured technique.Results
Prolapse repair was successfully achieved without complications. We had already published a series of 20 cases that confirmed that transvaginal USLs hysteropexy is a promising technique for correcting genital prolapse with uterus preservation.Conclusion
Transvaginal USLs hysteropexy provides a feasible technique for apical support without the use of prosthetic material. This procedure could be attractive to women who desire a uterine-sparing surgical option.65.
66.
"Radical but conservative" is the main goal for ultrasonography-guided liver resection: prospective validation of this approach 总被引:3,自引:0,他引:3
Torzilli G Montorsi M Donadon M Palmisano A Del Fabbro D Gambetti A Olivari N Makuuchi M 《Journal of the American College of Surgeons》2005,201(4):517-528
BACKGROUND: Despite higher blood loss, morbidity, and mortality, rate of major resection is still high in most surgical institutions because of fear of incomplete tumor removal. To verify whether intraoperative ultrasonography (IOUS) minimizes the rate of major hepatectomies while maintaining treatment radicality, we have prospectively validated our policy, based on extensive use of IOUS resection guidance. STUDY DESIGN: Ninety-three consecutive patients with liver tumors were prospectively enrolled. There were 61 men and 32 women with a mean age of 65.6 years. Fifty-nine patients had hepatocellular carcinoma and 34 had colorectal cancer liver metastases. Surgical strategy was based on the relationship between the tumor and intrahepatic vascular structures at IOUS. Rates of major and minor resection, mortality, morbidity, and rate of local recurrences were evaluated. RESULTS: There was no hospital mortality; major morbidity occurred in 2.2% of patients and minor complications in 17%. Six (6.5%) patients required blood transfusion. Major resections (two or more segments) were accomplished in 14 patients (15%), and 5 (5.4%) patients had more than three segments removed. Major vascular invasion was present in 16 patients (17%), and contact without infiltration with major vessels was present in another 16; part of the wall of the inferior vena cava was resected in 1 patient. Surgical clearance was achieved in all patients without local recurrence at a mean followup of 18 months (median 13, range 6 to 52 months). CONCLUSIONS: This study shows that liver operations performed under IOUS guidance are safe and radical and reduce need for major hepatectomies. 相似文献
67.
68.
Roberto Santambrogio MD Enrico Opocher MD Massimo Zuin MD Carlo Selmi MD PhD Emanuela Bertolini MD Mara Costa MD Matteo Conti MD Marco Montorsi MD 《Annals of surgical oncology》2009,16(12):3289-3298
Background
This study compared two homogeneous groups of patients submitted to either surgical resection (HR) or laparoscopic radiofrequency ablation (LRFA) for the treatment of hepatocellular carcinoma (HCC). When compatible with the liver functional reserve, HR remains the treatment of choice for HCC, while LRFA seems to be a promising, less invasive alternative. We thus compared HR or LRFA for short- and long-term outcomes in patients with a single HCC nodule and Child-Pugh class A liver cirrhosis. 相似文献69.
Alessandro Cucchetti MD Fabio Piscaglia MD Eugenio Caturelli MD Luisa Benvegnù MD Marco Vivarelli MD Giorgio Ercolani MD Matteo Cescon MD Matteo Ravaioli MD Gian Luca Grazi MD Luigi Bolondi MD Antonio Daniele Pinna MD 《Annals of surgical oncology》2009,16(2):413-422
The presence of cirrhosis is the only risk factor that is advocated for recurrence of hepatocellular carcinoma (HCC) 2 years
after hepatic resection compared with noncirrhotic control subjects; however, data for cohorts of exclusively patients with
cirrhosis are lacking. This study was designed to assess risk factors and annual incidence of early (<2 years) and late (>2 years)
recurrence after resection of cirrhosis and to compare these findings with those of patients with cirrhosis enrolled in HCC
surveillance programs (HCC occurrence). Data from 204 patients with cirrhosis resected for HCC and 150 surveilled for cirrhosis
were retrospectively collected and compared using propensity score matching to overcome biases of nonrandomized study. Risk
factors for early recurrence (incidence = 21.8%/year) were higher serum alpha-fetoprotein (AFP) levels, poorly differentiated
tumor, and presence of microvascular invasion (P < 0.05). Risk factors for both late recurrence (18.4%/year) and HCC occurrence (3.3%/year) were male gender, older age, and
higher serum transaminase levels; multiple primary tumors and higher AFP were additional risk factors for late recurrence
and HCC occurrence respectively (P < 0.05). After propensity adjustment, resected patients with less than two risk factors for late recurrence showed an annual
incidence of HCC (6.2%/year) similar to that of surveilled patients with ≥2 risk factors (5.8%/year; P = 0.898). Early and late recurrence of HCC for patients with cirrhosis after resection have distinct risk factors. Annual
incidence of HCC 2 years or more after resection may be similar to that of general patients because the same risk factors
are involved; assessment of these characteristics could be useful in tailoring clinical management. 相似文献
70.
Daniele Focosi Matteo Pelosini Piero Palla Sara Galimberti Francesco Caracciolo Edoardo Benedetti Federico Papineschi Mario Petrini 《Transplant immunology》2009,21(4):240-243
We report here a 50-years old female with multiple myeloma-associated chronic renal failure who underwent high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. She developed progressive encephalopathy on day 5 progressing to coma despite hemodialysis and no obvious organ failure. She finally recovered after a single 1-liter plasma exchange. The final diagnosis was metabolic encephalopathy due to hypercytokinemia, particularly high serum TNF levels. We discuss here the pathogenesis and raise an alert for monitoring cytokine levels in patients with renal failure undergoing high-dose chemotherapy. 相似文献